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The Minimal Important Difference in the Borg Dyspnea Score for Patients with Pulmonary Arterial Hypertension

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Stephen Mathai

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Despite advances in therapy, pulmonary arterial hypertension (PAH) remains a chronic disease without a cure. Focusing on patient symptoms such as dyspnea is an important part of assessing response to therapy.

Background: Despite advances in therapy, pulmonary arterial hypertension (PAH) remains a chronic disease without a cure. Focusing on patient symptoms such as dyspnea is an important part of assessing response to therapy. Little is known regarding clinically meaningful changes in dyspnea in patients with PAH.

Methods: 129 PAH patients were included. Baseline demographics, clinical characteristics along with six-minute walk test (6MWT), Borg dyspnea (BD) and fatigue (BF) scores at baseline and follow up after 3 months of PAH therapy were collected. The minimal important difference (MID) for the BD and BF scores were determined using distributional and anchor-based methods, where 6MWT served as the anchor.

Results: The majority of subjects were white women who were, on average, 51 years old.  Nearly 50% of subjects had idiopathic PAH; 44% had PAH related to connective tissue disease.  The majority had NYHA functional class of II or III and had moderate-to-severe PAH. Baseline BD score was 3.4±1.9 units; BF score was 2.8±2.2 units. After therapy, the average change in BD score was -0.16±1.9 units; for BF, -0.21±2.4 units. Using distributional methods, the MID for BD ranged from 0.7 to 1.24 units and for BF ranged from 0.73 to 1.39 units, as shown in Table 1.  Using anchor-based methods, the MID for the BD score was 0.36; this could not be calculated for BF.

The Minimal Important Difference in the Borg Dyspnea Score for Patients with Pulmonary Arterial Hypertension - Table 1

Method

MID Estimate for BD

MID Estimate  for BF

Anchor

0.36

Not attainable*

ES

0.70

0.73

SRM

0.98

0.92

SEMeas

0.96

1.09

0.5SD

1.24

1.39

*Inadequate correlation with anchor

 

Conclusions: Using distributional and anchor-based methods, we estimate the MID for the BD in PAH is < 1 unit and around 1 unit for BF. This MID is smaller than reported MID for other pulmonary diseases such as COPD and may reflect differences in the perception of dyspnea between diseases. Further research is needed to determine the clinical utility of BD and BF in the assessment of PAH patients.