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

• Published in: Clinics (São Paulo, Brazil) Vol. 69; no. 5; pp. 341 - 346
• Main Authors: Weber, Cristina K, Miglioranza, Marcelo H, de Moraes, Maria A P, Sant'anna, Roberto T, Rover, Marciane M, Kalil, Renato A K, Leiria, Tiago Luiz L
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01.01.2014; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Adult; Brazil; Clinical Science; Cohort Studies; Dyspnea; Dyspnea - etiology; Dyspnea - physiopathology; Female; Follow-Up Studies; Heart Failure; Heart Failure - complications; Heart Failure - physiopathology; Humans; Likert Scale; Male; MEDICINE, GENERAL & INTERNAL; Middle Aged; Natriuretic Peptide, Brain - analysis; Outpatients; Peptide Fragments - analysis; Prognosis; Prospective Studies; Psychometrics - instrumentation; Pulmonary Edema - complications; Pulmonary Edema - diagnosis; Pulmonary Edema - diagnostic imaging; Ultrasonography; Ventricular Function, Left - physiology; Heart Failure; Dyspnea; Likert Scale
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2014(05)08

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. 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. 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). 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.