Symptom burden in heart failure: assessment, impact on outcomes, and management

Abstract

Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.

Palliative Care in Heart Failure

“…There are varying levels of evidence for treating HF symptoms (20). Often, the ideal HF symptom management approach is treating the underlying HF condition (e.g., relieving dyspnea by addressing fluid overload); this is a clear example of the harmony between traditional HF disease management and a palliative approach (21).…”

Symptom Diary Use and Improved Survival for Patients With Heart Failure

“…Symptoms can be a predictor of adverse clinical events in a dose-dependent fashion (all-cause mortality, hospital admission, emergency department visit, ventricular assist device implantation, and heart transplantation), 31,32 thus attention to symptoms is critical to avoid complications. In one study, patients with HF with moderate symptom burden were 82% more likely than those with low symptom burden to have an adverse clinical event within a year, and patients with severe burden were more than twice as likely.…”

“…As more life-prolonging treatments become available, our evidence base for HF symptom assessment and management must increase so that we can improve morbidity and mortality as well as symptom burden and quality of life in this challenging patient population. 31 …”

Behind the Screen: –Internet-Based Cognitive Behavioural Therapy to Treat Depressive Symptoms in Persons with Heart Failure

“…The burden of symptoms in heart failure is often comparable with that in advanced cancer [15] and other serious diseases [12]. Persons with heart failure report that difficulties sleeping, other pain, lack of energy, feeling drowsy, and dyspnoea are the most severe symptoms experienced.…”

“…Some symptoms are common in both depression and heart failure, such as fatigue [12,64]. Other symptoms are more common in one condition compared to the other but can occur in both, such as weight change, which is more common in heart failure than in depression.…”