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Measurement of Dyspnea in Ambulatory African Americans With Heart Failure and a Preserved or Reduced Ejection Fraction

Vuckovic, Karen M. PhD, RN, ACNS; DeVon, Holli A. PhD, RN; Piano, Mariann R. PhD, RN

doi: 10.1097/JCN.0000000000000205
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Background: Dyspnea is a burdensome and disabling heart failure (HF) symptom. Few studies examining dyspnea in HF have included African Americans (AAs), despite their developing HF at a younger age and having the highest mortality rates.

Objective: The purpose of this cross-sectional study was to examine dyspnea in AA patients with HF and a preserved ejection fraction (HFpEF) compared with those with a reduced ejection fraction (HFrEF), before and after the 6-minute walk test (6MWT).

Methods: A convenience sample of ambulatory AA patients (HFrEF, n = 26; HFpEF, n = 19) 50 years or older was recruited from an urban HF clinic. The Borg Scale and a visual analog scale (VAS) were used to measure dyspnea intensity before and after the 6MWT. Activity limitations related to dyspnea were described using the modified Medical Research Council Dyspnea Scale. Group comparisons were analyzed using repeated-measures analysis of variance and χ2 tests. Convergent validity was determined between the Borg and VAS using Bland-Altman plots.

Results: No significant differences were found in age, gender, and comorbidities between HF groups. Most HFpEF patients reported dyspnea at baseline (Borg, 63%; VAS, 73%) and after the 6MWT (Borg, 78%; VAS, 79%). In the HFrEF group, the prevalence of baseline dyspnea was greater when measured with the VAS (Borg, 34%; VAS, 80%) but was similar between instruments after the 6MWT (Borg, 64%; VAS, 77%). Both groups reported a similar change in dyspnea intensity during and after the 6MWT. The Bland-Altman plots indicated moderate agreement at each time point. Most patients described walking hurriedly or uphill as dyspnea-provoking on the Modified Respiratory Council Dyspnea Scale.

Conclusions: The prevalence of dyspnea at baseline and after the 6MWT was high for both groups, but intensity varied with the dyspnea instrument used.

Karen M. Vuckovic, PhD, RN, ACNS Assistant Clinical Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago.

Holli A. DeVon, PhD, RN Associate Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago.

Mariann R. Piano, PhD, RN Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago.

Funding for this research was provided by the Midwest Roybal Center for Health Promotion and Translation (MRCHPT) which is supported by a center grant from the National Institute on Aging/National Institutes of Health (NIA/NIH) grant 5P30AG022849-07. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the MRCHPT and NIA/NIH.

The authors have no conflicts of interest to disclose.

Correspondence Karen M. Vuckovic, PhD, RN, ACNS, College of Nursing, University of Illinois at Chicago, UIC (MC 802), 845 S Damen Ave, Chicago, IL 60612 ( vuckovic@uic.edu).

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