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Acil Serviste Akut Kalp Yetmezliği Hastalarında Nefes Darlığının Üç Skala ile Değerlendirilmesi

Year 2023, Volume: 6 Issue: 1, 1 - 6, 08.03.2023
https://doi.org/10.54996/anatolianjem.1053506

Abstract

Amaç: Bu çalışmada, acil serviste (AS) akut kalp yetmezliği (AHF) olan hastalarda üç dispne ölçeğini (Likert, VAS ve NRS) karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Acil serviste AHF tanısı konan hastalarda prospektif olarak yapılan bu çalışmaya toplam 114 hasta dahil edildi. Başvuru sırasında ve 4. saatte dispne skalaları dispne şiddeti açısından değerlendi. Likert, Visual Analog Skala (VAS) ve Sayısal Derecelendirme Ölçeği (SDÖ) kullandı.

Bulgular: Çalışmaya katılan hastaların altmış beşi kadındı. Hastaların ortalama yaşı 72.1 ± 11.7 yıl idi. Nefes darlığı düzelen hastaların %74,1'i taburcu edildi. Hastaların 77'si acil servisten taburcu edilirken 37'si hastaneye yatırıldı ve yatan hastaların %51,7'sinde nefes darlığında düzelme olmadı. Her skalada tedaviden sonra dispne şiddeti azaldı (p<0.05). Dördüncü saat skorları her üç ölçek için düşüktü (p<0.01), ancak hastanede yatan hastalarda 4. saat VAS ve NRS skorları taburcu olana göre daha yüksekti (p<0.01). Dispne skalalarının başvuru ve 4. saatinde de benzer anlamlı doğrusal ilişki bulundu (p<0.001).

Sonuç: Acil serviste AKY olan hastalarda dispne skalaları nefes darlığında düzelme ve klinik rahatlama ile uyumludur, buna karşın nefes darlığındaki düzelme hastaların hastaneye yatırılması mı yoksa taburcu edilmesi mi gerektiğine karar vermek için yetersizdir.

References

  • Pang PS, Collins SP, Sauser K, Andrei A-C, Storrow AB, Hollander JE, et al. Assessment of Dyspnea Early in Acute Heart Failure: Patient Characteristics and Response Differences Between Likert and Visual Analog Scales. Acad Emerg Med. 2014 Jun;21(6):659–66.
  • Mebazaa A, Pang PS, Tavares M, Collins SP, Storrow AB, Laribi S, et al. The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study. Eur Heart J. 2010 Apr;31(7):832–41.
  • Smithline HA, Caglar S, Blank FSJ. Physician vs patient assessment of dyspnea during acute decompensated heart failure. Congest Heart Fail. 2010 Apr;16(2):60–4.
  • Ozalevli S, Ucan ES. The comparison of different dyspnoea scales in patients with COPD. J Eval Clin Pract. 2006 Oct;12(5):532–8.
  • Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000 Jun;26(3):216–22.
  • Metra M, Ponikowski P, Cotter G, Davison BA, Felker GM, Filippatos G, et al. Effects of serelaxin in subgroups of patients with acute heart failure: results from RELAX-AHF. Eur Heart J. 2013 Oct;34(40):3128–36.
  • Mahler DA, Horowitz MB. Clinical evaluation of exertional dyspnea. Clin Chest Med. 1994 Jun;15(2):259–69.
  • Wysham NG, Miriovsky BJ, Currow DC, Herndon JE, Samsa GP, Wilcock A, et al. Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity. J Pain Symptom Manage. 2015 Oct;50(4):480–7.
  • Pang PS, Konstam MA, Krasa HB, Swedberg K, Zannad F, Blair JEA, et al. Effects of tolvaptan on dyspnoea relief from the EVEREST trials. Eur Heart J. 2009 Sep 1;30(18):2233–40.
  • Pang PS, Cleland JGF, Teerlink JR, Collins SP, Lindsell CJ, Sopko G, et al. A proposal to standardize dyspnoea measurement in clinical trials of acute heart failure syndromes: the need for a uniform approach. Eur Heart J. 2008 Mar;29(6):816–24.
  • Allen LA, Metra M, Milo-Cotter O, Filippatos G, Reisin LH, Bensimhon DR, et al. Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: MEASURE-AHF. J Card Fail. 2008 Nov;14(9):777–84.
  • Placido R, Gigaud C, Gayat E, Ferry A, Cohen-Solal A, Plaisance P, et al. Assessment of dyspnoea in the emergency department by numeric and visual scales: A pilot study. Anaesth Crit Care Pain Med. 2015 Apr;34(2):95–9.
  • Perez-Moreno AC, Jhund PS, Macdonald MR, Petrie MC, Cleland JGF, Böhm M, et al. Fatigue as a predictor of outcome in patients with heart failure: analysis of CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure). JACC Heart Fail. 2014 Apr;2(2):187–97.
  • Llorens P, Javaloyes P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Gil V, et al. Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clinical Research in Cardiology. 2018 Oct;107(10):897–913.
  • West RL, Hernandez AF, O'Connor CM, Starling RC, Califf RM. A review of dyspnea in acute heart failure syndromes. Am Heart J. 2010 Aug;160(2):209–14

Assessment of Dyspnea in Acute Heart Failure Patients with Three Scales in the Emergency Department

Year 2023, Volume: 6 Issue: 1, 1 - 6, 08.03.2023
https://doi.org/10.54996/anatolianjem.1053506

Abstract

Aim: This study aimed to compare the three dyspnea scales (Likert, VAS, and NRS) in patients with acute heart failure (AHF) in the emergency department (ED).

Materials and Methods: This study enrolled 114 patients prospectively diagnosed with AHF in the ED. We assessed the dyspnea scales for severity at admission and the 4th hour. We used the Likert scale, Visual Analogue Scale (VAS), and the Numerical Rating Scale (NRS).

Results: Sixty-five patients were women. The mean age of the patients was 72.1 ± 11.7 years. 74.1% of the patients whose dyspnea was relieved were discharged. Seventy-seven of the patients were discharged from ED, while 37 were hospitalized, and 51.7% of the hospitalized patients had no improvement in dyspnea. The severity of dyspnea decreased after the treatment on each scale (p< 0.05). The 4th-hour scores were lower for all three scales (p< 0.01), but VAS and NRS scores on the 4th hour were higher in hospitalized patients than in discharged (p< 0.01). There was a similarly significant relationship between the admission and 4th hour of dyspnea scales (p<0.001).

Conclusion: Dyspnea scales are compatible with dyspnea and clinical relief in patients with AHF in the ED, whereas improvement in dyspnea is insufficient to decide whether the patient should be hospitalized or discharged.

References

  • Pang PS, Collins SP, Sauser K, Andrei A-C, Storrow AB, Hollander JE, et al. Assessment of Dyspnea Early in Acute Heart Failure: Patient Characteristics and Response Differences Between Likert and Visual Analog Scales. Acad Emerg Med. 2014 Jun;21(6):659–66.
  • Mebazaa A, Pang PS, Tavares M, Collins SP, Storrow AB, Laribi S, et al. The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study. Eur Heart J. 2010 Apr;31(7):832–41.
  • Smithline HA, Caglar S, Blank FSJ. Physician vs patient assessment of dyspnea during acute decompensated heart failure. Congest Heart Fail. 2010 Apr;16(2):60–4.
  • Ozalevli S, Ucan ES. The comparison of different dyspnoea scales in patients with COPD. J Eval Clin Pract. 2006 Oct;12(5):532–8.
  • Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000 Jun;26(3):216–22.
  • Metra M, Ponikowski P, Cotter G, Davison BA, Felker GM, Filippatos G, et al. Effects of serelaxin in subgroups of patients with acute heart failure: results from RELAX-AHF. Eur Heart J. 2013 Oct;34(40):3128–36.
  • Mahler DA, Horowitz MB. Clinical evaluation of exertional dyspnea. Clin Chest Med. 1994 Jun;15(2):259–69.
  • Wysham NG, Miriovsky BJ, Currow DC, Herndon JE, Samsa GP, Wilcock A, et al. Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity. J Pain Symptom Manage. 2015 Oct;50(4):480–7.
  • Pang PS, Konstam MA, Krasa HB, Swedberg K, Zannad F, Blair JEA, et al. Effects of tolvaptan on dyspnoea relief from the EVEREST trials. Eur Heart J. 2009 Sep 1;30(18):2233–40.
  • Pang PS, Cleland JGF, Teerlink JR, Collins SP, Lindsell CJ, Sopko G, et al. A proposal to standardize dyspnoea measurement in clinical trials of acute heart failure syndromes: the need for a uniform approach. Eur Heart J. 2008 Mar;29(6):816–24.
  • Allen LA, Metra M, Milo-Cotter O, Filippatos G, Reisin LH, Bensimhon DR, et al. Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: MEASURE-AHF. J Card Fail. 2008 Nov;14(9):777–84.
  • Placido R, Gigaud C, Gayat E, Ferry A, Cohen-Solal A, Plaisance P, et al. Assessment of dyspnoea in the emergency department by numeric and visual scales: A pilot study. Anaesth Crit Care Pain Med. 2015 Apr;34(2):95–9.
  • Perez-Moreno AC, Jhund PS, Macdonald MR, Petrie MC, Cleland JGF, Böhm M, et al. Fatigue as a predictor of outcome in patients with heart failure: analysis of CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure). JACC Heart Fail. 2014 Apr;2(2):187–97.
  • Llorens P, Javaloyes P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Gil V, et al. Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clinical Research in Cardiology. 2018 Oct;107(10):897–913.
  • West RL, Hernandez AF, O'Connor CM, Starling RC, Califf RM. A review of dyspnea in acute heart failure syndromes. Am Heart J. 2010 Aug;160(2):209–14
There are 15 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Canan Kara Genoğlu This is me 0000-0001-5364-0288

Ataman Köse 0000-0002-3856-6582

Seyran Bozkurt Babuş 0000-0001-9503-2862

İbrahim Toker 0000-0002-5346-2116

Semra Erdoğan 0000-0003-2935-0760

Necati Muşlu This is me 0000-0002-4189-2282

Ahmet Çelik 0000-0002-9417-7610

Early Pub Date March 9, 2023
Publication Date March 8, 2023
Published in Issue Year 2023 Volume: 6 Issue: 1

Cite

AMA Kara Genoğlu C, Köse A, Bozkurt Babuş S, Toker İ, Erdoğan S, Muşlu N, Çelik A. Assessment of Dyspnea in Acute Heart Failure Patients with Three Scales in the Emergency Department. Anatolian J Emerg Med. March 2023;6(1):1-6. doi:10.54996/anatolianjem.1053506