Prognostic Value of Self-Reported Subjective Exercise Capacity in Patients With Acute Dyspnea

Maria Belkin; Desiree Wussler; Eleni Michou; Ivo Strebel; Nikola Kozhuharov; Zaid Sabti; Albina Nowak; Samyut Shrestha; Pedro Lopez-Ayala; Alexandra Prepoudis; Sabrina Stefanelli; Ibrahim Schäfer; Constantin Mork; Miriam Albus; Isabelle Danier; Cornelia Simmen; Tobias Zimmermann; Matthias Diebold; Tobias Breidthardt; Christian Mueller

doi:10.1016/j.jacadv.2023.100342

Prognostic Value of Self-Reported Subjective Exercise Capacity in Patients With Acute Dyspnea

JACC Adv. 2023 May 26;2(3):100342. doi: 10.1016/j.jacadv.2023.100342. eCollection 2023 May.

Authors

Maria Belkin^{1

2

3}, Desiree Wussler^{1

2

3}, Eleni Michou^{1

3}, Ivo Strebel¹, Nikola Kozhuharov^{1

3

4}, Zaid Sabti^{1

3}, Albina Nowak^{5

6}, Samyut Shrestha^{1

3}, Pedro Lopez-Ayala^{1

3}, Alexandra Prepoudis^{1

3}, Sabrina Stefanelli^{1

3}, Ibrahim Schäfer^{1

2

3}, Constantin Mork^{1

3}, Miriam Albus^{1

2

3}, Isabelle Danier^{1

3}, Cornelia Simmen^{1

3}, Tobias Zimmermann^{1

3}, Matthias Diebold^{1

3}, Tobias Breidthardt^{1

2

3}, Christian Mueller^{1

3}

Affiliations

¹ Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
² Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
³ GREAT network, Rome, Italy.
⁴ Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
⁵ Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
⁶ Division of Internal Medicine, University Psychiatry Clinic Zurich, Zurich, Switzerland.

Abstract

Background: Self-reported exercise capacity is a well-established prognostic measure in stable ambulatory patients with cardiac and pulmonary disease.

Objectives: The authors aimed to directly compare the prognostic accuracy of quantified self-reported exercise capacity using the Duke Activity Status Index (DASI) with the established objective disease-severity marker B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea to the emergency department.

Methods: The DASI was obtained in a prospective multicenter diagnostic study recruiting unselected patients presenting with acute dyspnea to the emergency department. The prognostic accuracy of DASI and BNP for 90-day and 720-day all-cause mortality was evaluated using C-index.

Results: Among 1,019 patients eligible for this analysis, 75 (7%) and 297 (29%) patients died within 90 and 720 days after presentation, respectively. Unadjusted hazard ratios (HRs) and multivariable adjusted hazard ratios (aHRs) for 90- and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI quartile (worst self-reported exercise capacity). For 720-day mortality the HR of the first quartile vs the fourth was 9.1 (95% CI, 5.5-14.9) vs (aHR: 6.1, 95% CI: 3.7-10.1), of the second quartile 6.4 (95% CI: 3.9-10.6) vs (aHR: 4.4, 95% CI: 2.6-7.3), while of the third quartile the HR was 3.2 (95% CI: 1.9-5.5) vs (aHR: 2.4, 95% CI: 1.4-4.0). The prognostic accuracy of the DASI score was high, and higher than that of BNP concentrations (720-day mortality C-index: 0.67 vs 0.62; P = 0.024).

Conclusions: Quantification of self-reported subjective exercise capacity using the DASI provides high prognostic accuracy and may aid physicians in risk stratification. (Basics in Acute Shortness of Breath EvaLuation [BASEL V] Study [BASEL V]; NCT01831115).

Keywords: Duke Activity Status Index; acute dyspnea; acute heart failure; self-reported exercise capacity.

Associated data

ClinicalTrials.gov/NCT01831115