Quin Denfeld, PhD, is an associate professor at Oregon Health & Science University.

Quin Denfeld, PhD

Although dyspnea generally improves in patients after 

 hospitalization, symptoms can remain persistent or worsen in >1/3 of all cases, according to data from the BIOMES-HF study.

Dyspnea Worsens in 1 in 3 Patients Following Discharge from HF Hospitalization

Quin Denfeld, PhD, associate professor at Oregon Health & Science University, presented these data at the 

Heart Failure Society of America (HFSA) Annual Scientific Meeting 2026

 in Phoenix, Arizona, by Quin Denfeld, PhD, associate professor at Oregon Health & Science University. In an interview with 

, Denfeld discussed the implications of her research and why these symptoms are critically important.

“The cardinal symptom of heart failure is dyspnea, or shortness of breath. That’s what brings people into the hospital,” Denfeld told 

. “We wanted to see, after that hospitalization, how did these patients fare afterwards in terms of their dyspnea? Did it go up? Did it go down? Did it stay the same?”

The Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) study was a longitudinal cohort program in which Denfeld and colleagues aimed to identify clusters of changes in symptoms after an HF hospitalization. Patients were eligible for inclusion if they had a diagnosis of New York Heart Association (NYHA) Class 2-4 HF by physical exam and echocardiographic evidence. Patients with a previous heart transplant or ventricular assist device, among other criteria, were excluded.

Denfeld and colleagues categorized patients as HF with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) based on their initial presentation at diagnosis, regardless of any improvement in EF during treatment. They measured dyspnea using the 6-item Heart Failure Somatic Perception Scale Dyspnea Subscale (HFSPS-D), which is a 0-5 scale asking patients how much they were bothered by common HF symptoms, totaling 30 potential points. Additionally, the team used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to determine quality of life changes in each patient.

A total of 219 patients were enrolled in the trial, with an average age of 63.1 +/- 13.9 years. The majority of patients (n = 136) were categorized as having HFrEF, while 83 had HFpEF. Most patients were also NYHA functional class 3 at baseline and had been hospitalized for a median of 7 days (interquartile range [IQR], 5-12).

Denfeld and colleagues divided patients into 3 main trajectories: improving dyspnea, stable/mid-level dyspnea, and worsening dyspnea. Of the 219 enrolled patients, 139 (63.4%) were classified as improving dyspnea, 38 (17.4%) were classified as stable/moderate, and 42 (19.2%) had worsening dyspnea. Differences in KCCQ quality-of-life scores were also statistically significant at discharge, with patients in the improving dyspnea category having the greatest improvement compared to those in stable/mid-level and worsening dyspnea.

Additionally, the team highlighted changes in a variety of other symptom measures. There were significant differences in fatigue at discharge, but not in fatigue over time. Denfeld and colleagues also saw differences in sleep impairment at discharge, but not in sleep impairment over time. Cognitive symptoms followed a similar trend, including anxiety and depressive symptoms.

Ultimately, while Denfeld and colleagues found that the majority of patients were discharged with stable or improved dyspnea, a significant proportion also exhibited worsening dyspnea in the period immediately following their release. The team concluded that further research is needed to validate these trajectories in larger studies and across multiple sites to represent the HF population more broadly.

“The bottom line is that patients have shortness of breath, but the degree to which it bothers them, to which they experience it, varies,” Denfeld said. “It’s just as important to recognize that symptoms aren’t a one-size-fits-all for patients – they experience them differently. Looking at the symptoms, tracking them over time, and being more diligent in understanding these changes is something that we really need to home in on for the future.”

Editors’ Note: Denfeld reports support from the National Institutes of Health/National Institute of Nursing Research.

Denfeld QE, Hiatt SO, Camacho SA, et al. Trajectories of dyspnea after heart failure hospitalization: A prospective longitudinal cohort study. 

Denfeld QE, Camacho SA, Dieckmann N, et al. Background and design of the biological and physiological mechanisms of symptom clusters in heart failure (biomes-HF) study. Journal of Cardiac Failure. 2022;28(6):973-981. 

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Quin Denfeld, PhD, discusses her findings from the BIOMES-HF study, indicating worsening symptoms in patients with HF over time.

Quin Denfeld, PhD

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