Thirty-Day Analysis of Dyspnea and Edema in Heart Failure Subjects

Abstract

Background: Heart failure (HF) is a growing epidemic in the United States. To date, there are 5 million diagnosed cases of heart failure in the United States and there continues to be approximately 400,000 new cases diagnosed each year. Heart failure primarily affects the elderly, specifically 10 out of every 1000 individuals over the age of 65. Given this, as the population of America ages, there will undoubtedly be an increase in the number of diagnosed patients with HF.

Purpose: The purpose of this study was to characterize daily fluctuations in self-reported dyspnea and edema, and body weight in subjects with the New York Heart Association class I through IV for one month. Our specific aims were: 1.To describe daily fluctuations in self-reported dyspnea and edema and body weight by heart failure classification 2.To examine relationships between self-reported dyspnea and edema and body weight in this cohort

Method: This was a descriptive correlational sub-study of a larger investigation of appetite and inflammation in heart failure. Subjects (n = 48) were recruited from 3 Midwestern clinics. Subjects were referred to the investigators by cardiologists and nurse practitioners and those referred subjects were contacted by telephone and invited to participate in the study. After consent, the subjects provided demographic data and the following daily for 30 days: (a) self report of dyspnea and edema symptom rating scales (10 = no symptom to 0 = worst symptom experienced) and (b) body weight at same time daily using a consistent scale.

Results: This study had 48 participants with a mean age of 48 +14.7 years. Fifty-four per cent were male. The average daily rating of dyspnea ranged from 5.2-6.9, indicating moderate daily dyspnea. There were daily fluctuations, for example, the average daily rating on day 3 was 5.2 and on day 6 the average rating was 5.9. The average daily rating of self-reported edema ranged from 3.0 to 5.2, indicating moderate to severe daily self-reported edema. There were fewer daily fluctuations in self-reported edema. The investigators found that daily during the 30-day period the relationship between self-reported dyspnea and edema was a positive, significant relationship (p < 0.01). This signified that as a participant reported more edema, there was a corresponding increase in his or her dyspnea. The relationship between self- reported dyspnea and body weight was significant approximately half of the time (p < 0.05). This indicated that as body weight increased, self reported dyspnea increased. The correlation between body weight and self-reported edema was not significant.

Conclusion/Implications: For the 30-day study period, subjects with heart failure reported moderate levels of self reported dyspnea and edema. The mean dyspnea rating was significantly associated with changes in body weight indicating that fluid retention increased the sensation of breathlessness. Self reported dyspnea was also associated with self-reported edema. Heart failure patients are able to monitor daily symptoms, detect small changes and may be able to modify self-care activities and therapeutic regimen based on these ratings.