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The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

Weber, Cristina K.; Miglioranza, Marcelo H.; Moraes, Maria A.P. De; Sant'Anna, Roberto T.; Rover, Marciane M.; Kalil, Renato A.K.; Leiria, Tiago Luiz L.

Clinics; v. 69 n. 5 (2014); 341-346

Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo 2014-01-01

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  • Título:
    The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients
  • Autor: Weber, Cristina K.; Miglioranza, Marcelo H.; Moraes, Maria A.P. De; Sant'Anna, Roberto T.; Rover, Marciane M.; Kalil, Renato A.K.; Leiria, Tiago Luiz L.
  • É parte de: Clinics; v. 69 n. 5 (2014); 341-346
  • Descrição: OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >;1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years) with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >;1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.
  • Títulos relacionados: https://www.revistas.usp.br/clinics/article/view/83741/86645
  • Editor: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
  • Data de criação/publicação: 2014-01-01
  • Formato: Adobe PDF
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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