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.
Highlights
Chronic heart failure (CHF) is a progressive, debilitating disease characterized by persistently reduced exercise capacity and acute exacerbations that lead to repeated hospital admissions.[1]
Many CHF patients become dependent on carers, which adversely affects their sense of identity and will to live.6,15The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial[16] interviewed 287 patients from initial hospitalization until 6 months of post-admission revealing that shortly after discharge, more than half were willing to trade survival time for improved symptom control, but once their symptoms had stabilized beyond 6 months, the majority (68%) prioritized survival
There are many treatments proven to improve symptoms, but they are infrequently employed because of a neutral effect on disease progression including diuretics, dobutamine, and morphine.21We propose that a shift in focus in clinical care and research towards symptom assessment and targeted management could improve QoL and quality of life years while being highly cost-effective and that new treatments should be assessed and considered for approval based upon their effect on symptoms rather than survival
Summary
Chronic heart failure (CHF) is a progressive, debilitating disease characterized by persistently reduced exercise capacity and acute exacerbations that lead to repeated hospital admissions.[1]. Prioritizing symptom management in clinics could reduce hospital readmissions and reduce the costs of care.[1,20] There are many treatments proven to improve symptoms, but they are infrequently employed because of a neutral (or negative) effect on disease progression including diuretics, dobutamine, and morphine.21We propose that a shift in focus in clinical care and research towards symptom assessment and targeted management could improve QoL and quality of life years while being highly cost-effective and that new treatments should be assessed and considered for approval based upon their effect on symptoms rather than survival Such a shift in priority will depend upon reliable, sensitive, and reproducible assessments of both classical and atypical symptoms of CHF. In this article, we discuss the common and less common symptoms of CHF and review the tools currently available for their assessment with the aim of prompting a greater focus on symptoms
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