Dyspnoea symptom intensity and impact on health-related quality of life in patients with cardiovascular or pulmonary diseases: a longitudinal observational study

Abstract

Introduction: Dyspnoea is a prevalent symptom associated with significantly reduced health-related quality of life (HRQoL). Accurate estimates of the severity and intensity of dyspnoea using standard tools in the clinic are important for the assessment of the severity of symptoms at later follow ups. Objectives: The current study had two aims. First, we sought to determine one-year changes in dyspnoea and health-related quality of life in patients with cardiac or respiratory diseases. Second, we sought to analyse the long-term associations between one-dimensional measurement methods and a generic instrument reflecting the multi-dimensionality of dyspnoea using the Short-Form Health Survey (SF-36). Methods: We prospectively recruited adult dyspnoeic patients in a rural primary health care centre. Participants were assessed for demographics, symptoms, medications, and N-terminal B-Type natriuretic pro-peptide (Nt-proBNP) level, and underwent spirometry and echocardiography. Results were analysed at baseline and one-year after enrolment. Based on the assessment results, we categorized the patients into one of three groups as the underlying disorder for dyspnoea: cardiovascular, pulmonary or psychiatric disease. Results: The ordinal scales [New York Heart Association (NYHA), modified Medical Research Council (mMRC) and Verbal Rating Scale (VRS)] indicated a slight but not significant decrease in dyspnoea severity, whereas the VAS showed a significant reduction in dyspnoea severity (p = 0.001) overall as well as in the cardiovascular group. By contrast, patients with pulmonary disease showed no improvement. HRQoL, as determined by the eight domains of SF-36, was unchanged, and dyspnoea severity had no impact on the worsening of health status. The correlation coefficient by test-re-test (reliability) of values at baseline and at the end of the study was highly significant. Conclusion: As appropriate measurements for the assessment of dyspnoea using one-dimensional scales, both mMRC and VAS should be considered for measuring changes in dyspnoea severity. VAS should be considered particularly for long-term changes in dyspnoeic patients with cardiovascular disorders. Changes in the different domains of the SF-36 were not seen after one year.