Evaluation of Novel Metrics of Symptom Relief in Acute Heart Failure: The Worst Symptom Score.


Journal Article

OBJECTIVE: To characterize a novel "worst"-symptom visual analogue scale (WS-VAS) versus the traditional dyspnea visual analogue scale (DVAS) in an acute heart failure (AHF) trial. BACKGROUND: AHF trials assess symptom relief as a pivotal endpoint with the use of dyspnea scores. However, many AHF patients' worst presenting symptom (WS) may not be dyspnea. We hypothesized that a WS-VAS may reflect clinical improvement better than DVAS in AHF. METHODS AND RESULTS: AHF patients (n = 232) enrolled in the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) Trial indicated their WS at enrollment and completed DVAS and WS-VAS at enrollment and 24, 48, and 72 hours. Dyspnea was the WS in 61%, body swelling in 29%, and fatigue in 10% of patients. Clinical characteristics differed by WS. In all patients, DVAS scores were higher (less severe symptoms) than WS-VAS and the change in WS-VAS over 72 hours was greater than the change in DVAS (P < .001). Changes in DVAS were smaller in patients with body swelling and fatigue than in patients with dyspnea as their WS (P = .002), whereas changes in the WS-VAS were similar regardless of patients' WS. Neither score, nor its change, was associated with available decongestion markers (change in N-terminal pro-B-type natriuretic peptide, weight or cumulative 72-hour urine volume). CONCLUSIONS: Many AHF patients have symptoms other than dyspnea as their most bothersome symptom. The WS-VAS better reflects symptom improvement across the spectrum of AHF phenotypes. Symptom relief and decongestion were not correlated in this AHF study.

Full Text

Duke Authors

Cited Authors

  • AbouEzzeddine, OF; Wong, YW; Mentz, RJ; Raza, SS; Nativi-Nicolau, J; Kociol, RD; McNulty, SE; Anstrom, KJ; Hernandez, AF; Redfield, MM; NHLBI Heart Failure Clinical Research Network,

Published Date

  • November 2016

Published In

Volume / Issue

  • 22 / 11

Start / End Page

  • 853 - 858

PubMed ID

  • 26718344

Pubmed Central ID

  • 26718344

Electronic International Standard Serial Number (EISSN)

  • 1532-8414

Digital Object Identifier (DOI)

  • 10.1016/j.cardfail.2015.12.015


  • eng

Conference Location

  • United States