Comparative symptom biochemistry between moderate and advanced heart failure.
Christopher S Lee, Quin E Denfeld, Bradley E Aouizerat and 6 others
PMID 30314637WHAT IT FOUND
In moderate heart failure, higher stress, inflammation, and endothelial markers tracked worse symptoms.
In advanced heart failure, those links reversed or disappeared, with higher markers sometimes associated with fewer reported symptoms.
Key findings
01In moderate HF, higher NTproBNP was associated with worse early & subtle symptoms (r = 0.399); in advanced HF the association was negative and nonsignificant (r = −0.034).
02In moderate HF, higher sTNFαR1 was associated with worse pain severity (r = 0.293); in advanced HF the association was negative and nonsignificant (r = −0.076).
03Worse endothelial dysfunction was associated with worse dyspnea in moderate HF, but less dyspnea in advanced HF.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis was exploratory, so it is better for generating hypotheses than for guiding care. The data were cross-sectional, so the study cannot show how symptom-biomarker relationships change over time. The study focused on physical symptoms and did not examine affective symptoms. The advanced HF cohort consisted of patients about to receive an LVAD, so it represents a specific pre-LVAD group.
Declared interests
The advanced HF cohort was part of a U.S. National Institutes of Health-sponsored study, and biomarkers were measured in a National Center for Advancing Translational Sciences-supported core lab. The supplied text does not state author conflicts of interest.
The easy way to misread this
Do not read these biomarker-symptom links as a way to judge how bad a patient feels. The study was exploratory and cross-sectional, and the direction changed between moderate and advanced heart failure.