RESUMO
OBJECTIVES: We aimed to study whether patient-reported outcomes, measured by quality of life (QoL) and functional class, are sensitive to pleural effusion (PLE) in patients with heart failure (HF), and to study changes in QoL and functional class during follow-up of PLE. METHODS: A cohort of 62 patients from an outpatient HF clinic was included. The amount of PLE was quantified using a pocket-sized ultrasound imaging device. Self-reports of QoL and functional class were collected using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the New York Heart Association (NYHA) functional classification. RESULTS: At baseline, 26 (42%) patients had PLE of which 19 (31%) patients had moderate to severe amounts of PLE. Patients with no to mild PLE had a lower MLHFQ score (mean 42, SD 21) compared with patients with a moderate to severe amount of PLE (mean 55, SD 24), p=0.03. For 28 patients (45%) with follow-up data, we observed a linear improvement of the MLHFQ-score (3.2, 95% CI 1.2 to 5.1) with each centimetre reduction of PLE. Correspondingly, patient-reported NYHA-class followed the same pattern as the MLHFQ-score. CONCLUSIONS: Our study indicates that patient-reported outcome measures as MLHFQ may be sensitive tools to identify patients with HF at highest risk of symptomatic PLE and that treatment targeting reduction of PLE during follow-up is essential to improvement of QoL and functional capacity of outpatients with HF. TRIAL REGISTRATION NUMBER: NCT01794715; Results.
Assuntos
Insuficiência Cardíaca/terapia , Pacientes Ambulatoriais/psicologia , Medidas de Resultados Relatados pelo Paciente , Derrame Pleural/terapia , Qualidade de Vida/psicologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Estudos de Coortes , Diuréticos/uso terapêutico , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Pacientes Ambulatoriais/estatística & dados numéricos , Derrame Pleural/etiologia , Derrame Pleural/psicologia , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Routine assessment of volume state by ultrasound may improve follow-up of heart failure patients. AIMS: We aimed to study the feasibility and reliability of focused pocket-size ultrasound examinations of the pleural cavities and the inferior vena cava performed by nurses to assess volume state at an outpatient heart failure clinic. METHODS: Ultrasound examinations were performed in 62 included heart failure patients by specialized nurses with a pocket-size imaging device (PSID). Patients were then re-examined by a cardiologist with a high-end scanner for reference within 1 h. Specialized nurses were able to obtain and interpret images from both pleural cavities and the inferior vena cava and estimate the volume status in all patients. RESULTS: Time consumption for focused ultrasound examination was median 5 min. In total 26 patients had any kind of pleural effusion (in 39 pleural cavities) by reference. The sensitivity, specificity, positive and negative predictive values were high, all ≥ 92%. The correlations with reference were high for all measurements, all r ≥ 0.79. Coefficients of variation for end-expiratory dimension of inferior vena cava and quantification of pleural effusion were 10.8% and 12.7%, respectively. CONCLUSIONS: Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by PSID and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy.