Trajectories of Dyspnea After Heart Failure Hospitalization: A Prospective Longitudinal Cohort Study

Background Heart failure (HF) hospitalization is a sentinel event that impacts quality-of-life (QOL). However, there is limited understanding of how hallmark HF symptoms change post-hospitalization and which patients may benefit from transitional care interventions. Purpose To identify distinct trajectories of dyspnea 6-months post-HF hospitalization and how trajectories are associated with changes in other symptoms and QOL. Methods In this longitudinal cohort study, we recruited patients hospitalized with a primary diagnosis of HF. Data was collected prior to hospital discharge (i.e. baseline) and then 1-week and 1-, 3-, and 6-months post-hospitalization. Dyspnea symptoms were measured with the HF Somatic Perception Scale-Dyspnea. Other symptoms included fatigue, sleep impairment, pain interference, depression, anxiety, and cognition. QOL was measured with the Kansas City Cardiomyopathy Questionnaire-12. Growth mixture modelling was used to identify distinct trajectories of change in dyspnea symptoms, and latent growth curve modelling was used to compare how other symptoms and QOL changed across dyspnea trajectories, accounting for classification uncertainty. Results The cohort (n=219) was 63.1±13.9 years and 40% female, and most had HF with reduced ejection fraction (62%). We identified three distinct trajectories of change in dyspnea symptoms: improving (n=139; 63.4%), stable/mid-level (n=38; 17.4%), and worsening (n=42; 19.2%), which differed significantly by baseline values (p<0.001) and trajectory of dyspnea over time (∆ slope p<0.001). There was a graded worsening in symptoms of fatigue, sleep impairment, pain interference, depression, and anxiety across the three dyspnea trajectories. There were significant differences in QOL at baseline (p=0.004) but no significant difference across time (p=0.480). Conclusions Dyspnea and QOL both improve in majority of patients after HF hospitalization, but symptoms remain persistent or worsen in over one-third. There is a need for effective strategies to ameliorate symptom burden for all patients in the vulnerable transition from hospital-to-home.