Prioritizing symptom management in the treatment of chronic heart failure

Abstract

Chronic heart failure (CHF) is a chronic, progressive disease that has detrimental consequences on a patient's quality of life (QoL). In part due to requirements for market access and licensing, the assessment of current and future treatments focuses on reducing mortality and hospitalizations. Few drugs are available principally for their symptomatic effect despite the fact that most patients' symptoms persist or worsen over time and an acceptance that the survival gains of modern therapies are mitigated by poorly controlled symptoms. Additional contributors to the failure to focus on symptoms could be the result of under-reporting of symptoms by patients and carers and a reliance on insensitive symptomatic categories in which patients frequently remain despite additional therapies. Hence, formal symptom assessment tools, such as questionnaires, can be useful prompts to encourage more fidelity and reproducibility in the assessment of symptoms. This scoping review explores for the first time the assessment options and management of common symptoms in CHF with a focus on patient-reported outcome tools. The integration of patient-reported outcomes for symptom assessment into the routine of a CHF clinic could improve the monitoring of disease progression and QoL, especially following changes in treatment or intervention with a targeted symptom approach expected to improve QoL and patient outcomes.

Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction

“… 5 Second, the barrier of ‘response’ is confusing and misplaced: does ‘response’ mean asymptomatic or merely improved? In our experience, while patients often feel better, they rarely become asymptomatic (NYHA (New York Heart Association) class 1), 12 an observation supported by real-world data even in those receiving ARNI. 13 14 Moreover, we should consider whether a highly subjective and poorly reproducible assessment is appropriate to determine our allocation of life-saving treatments.…”

Patient-centered Outcomes in HFrEF Following a Worsening Heart Failure Event: A Survey Analysis

“…17 This finding emphasizes the unmet need for HFrEF treatments that can better control symptoms, especially for patients with WHFEs, given the chronic nature of HF symptoms. 18 Second, psychological comorbidities have very important implications because they are associated with HF progression and poor prognosis and can impact patients' adherence to HF treatments. 19À21 Through the use of validated instruments to screen for depression, generalized anxiety disorder and insomnia, we found that patients with WHFEs experienced psychological comorbidities significantly more often and with greater severity than did patients with NWHFEs.…”

Trends in the development of Medicine, Biology and Pharmacy

“…Chronic heart failure (CHF) is a progressive clinical syndrome that adversely affects the patient's [321] quality of life and mainly affects the elderly; the incidence doubles in men and triples in women with each decade after age 65 [322]. The…”