140 - Orthopnea is Frequently Under-Reported in Routine Visits Despite its Impact on Quality of Life

Abstract

Introduction: Orthopnea is often thought to be restricted to heart failure (HF) decompensation with severe limitation of activities of daily living (ADL). Increased reliance on electronic templates with decreased time to elicit symptoms may limit appreciation of orthopnea in routine clinic visits. Orthopnea is a component of HF quality of life (QOL) questionnaires, but its isolated impact on QOL is not well-understood. Hypothesis: We hypothesized that patients may experience orthopnea more often than is currently elicited by physicians, and that orthopnea itself may decrease QOL. Methods: Prior to routine HF clinic visits, 932 patients completed written questionnaires, including frequency of HF-related difficulty breathing at night, limitations to common ADLs, and QOL graded 0–100 on a visual analog scale (VAS). Orthopnea was deemed present if patients reported sleeping sitting in a chair or propped on ≥2 pillows due to shortness of breath ≥1/ week in the preceding 4 weeks. Physician elicitation of orthopnea was determined by chart review of clinic notes from that visit. Results: Orthopnea was reported by 169 (16%) patients, and 59% of these had orthopnea every night. Although nearly all clinic notes (n = 916, 98%) mentioned if orthopnea was present or absent, it was recorded present for only 25% of patients who self-reported orthopnea. Self-reported orthopnea was associated with lower QOL VAS score (45 vs. 68, P < .001). More patients with orthopnea reported limitations to ADLs compared to those without orthopnea (dressing 71% vs. 19%, P < .001; showering/bathing 61% vs. 16%, P < .001). Among patients with any limitation to dressing, orthopnea was reported by 43% (n = 99), and associated with QOL VAS score 17 points lower than for those without orthopnea (39 vs. 56, P < .001). Orthopnea was reported by 7% (n = 44) of patients with no limitation to dressing, in whom it was still associated with QOL VAS score 17 points lower than for those without orthopnea (54 vs. 71, P < .001). The presence of orthopnea conferred worse overall QOL, regardless of whether or not patients had limitations to ADLs (Table 1). Conclusions: Orthopnea is commonly self-reported by patients with chronic HF on a focused questionnaire and is associated with worse QOL even in the absence of limitations to ADLs, but its presence is underestimated by physicians. These findings suggest that patients should be asked specifically about orthopnea at each clinic visit regardless of activity tolerance, in order to better identify and address QOL issues in chronic HF.