Determinants of dyspnea in chronic heart failure

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Abstract

Background

Dyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress.

Methods and Results

Dyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations.

Conclusions

The experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.

Key Words: Dyspnea ,heart failure, depression, anxiety, Type D, inflammation
Original languageEnglish
Pages (from-to)201-209
JournalJournal of Cardiac Failure
Volume22
Issue number3
DOIs
Publication statusPublished - 2016

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Depression
Receptors, Tumor Necrosis Factor, Type II
Interleukin-10
Interleukin-6
Body Mass Index
Tumor Necrosis Factor-alpha
Medically Unexplained Symptoms

Keywords

  • Dyspnea
  • Heart Failure
  • Depression
  • Anxiety
  • Type D
  • Personality
  • Inflammation

Cite this

@article{0dc144b1ca4f4941990a306e08991343,
title = "Determinants of dyspnea in chronic heart failure",
abstract = "BackgroundDyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress.Methods and ResultsDyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70{\%} men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations.ConclusionsThe experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.Key Words: Dyspnea ,heart failure, depression, anxiety, Type D, inflammation",
keywords = "Dyspnea, Heart Failure, Depression, Anxiety, Type D, Personality, Inflammation",
author = "N. Kupper and C.S. Bonhof and Bert Westerhuis and J.W.M.G. Widdershoven and J. Denollet",
note = "Copyright {\circledC} 2015 Elsevier Inc. All rights reserved.",
year = "2016",
doi = "10.1016/j.cardfail.2015.09.016",
language = "English",
volume = "22",
pages = "201--209",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
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}

Determinants of dyspnea in chronic heart failure. / Kupper, N.; Bonhof, C.S.; Westerhuis, Bert; Widdershoven, J.W.M.G.; Denollet, J.

In: Journal of Cardiac Failure, Vol. 22, No. 3, 2016, p. 201-209.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Determinants of dyspnea in chronic heart failure

AU - Kupper, N.

AU - Bonhof, C.S.

AU - Westerhuis, Bert

AU - Widdershoven, J.W.M.G.

AU - Denollet, J.

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2016

Y1 - 2016

N2 - BackgroundDyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress.Methods and ResultsDyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations.ConclusionsThe experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.Key Words: Dyspnea ,heart failure, depression, anxiety, Type D, inflammation

AB - BackgroundDyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress.Methods and ResultsDyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations.ConclusionsThe experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.Key Words: Dyspnea ,heart failure, depression, anxiety, Type D, inflammation

KW - Dyspnea

KW - Heart Failure

KW - Depression

KW - Anxiety

KW - Type D

KW - Personality

KW - Inflammation

U2 - 10.1016/j.cardfail.2015.09.016

DO - 10.1016/j.cardfail.2015.09.016

M3 - Article

VL - 22

SP - 201

EP - 209

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 3

ER -