Effort Oxygen Saturation and Effort Heart Rate to Detect Exacerbations of Chronic Obstructive Pulmonary Disease or Congestive Heart Failure

Abstract

Background: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. Methods: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) 80%, and Youden index 0.2) were integrated into diagnostic algorithms. Results: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO(2)) decrease 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase 10 beats/min and walking distance decrease 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75-0.97), Sp: 0.89 (95%, CI: 0.72-0.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85-0.995)); and for HF: SaO(2) decrease 2% in the mean-of-effort, HR increase 10 beats/min in the mean-of-effort, and walking distance decrease 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69-0.93), Sp: 0.75 (95%, CI: 0.57-0.87) and AUC 0.84 (95%, CI: 0.74-0.94)). Conclusions: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes.