This study assessed agreement between physician and patient self-reported measures of dyspnea severity during acute decompensated heart failure (ADHF). Both the physician and patient measured the change in dyspnea severity over 1 hour using 2 methods: (1) the difference of two static dyspnea measures (STATIC) and (2) a single transitional measure (TRANS). Likert scales and visual analog scales (VASs) were used. Data on 112 patients were analyzed. The mean difference between physician and patient VAS scores was 1 mm (limits of agreement: -54 to 56 mm) using the STATIC data. For TRANS data, the mean difference was 5 mm (limits of agreement: -75 to 86 mm). For the Likert scales, the weighted kappa was 0.13 and 0.23 for STATIC and TRANS data, respectively. The wide limits of agreement restrict our ability to substitute physician assessment for patient self-assessment of dyspnea in patients with ADHF.