Symptoms Used In Heart Failure Research And Reviewed By Patients And Clinicians

Abstract

<h3>Introduction</h3> Patients with heart failure (HF) commonly experience multiple symptoms. Increasing symptom burden can lead to HF decompensation and frequent use of healthcare resource including rehospitalization. Even though the American Heart Association (AHA) lists seven symptoms as common HF-related symptoms, many HF studies have used additional symptoms to measure patient outcomes. Our goal was to identify symptoms associated with heart failure from contemporary literature and obtain patient and clinician perspective on their importance. <h3>Aim</h3> . To determine frequent symptoms used in research to improve HF outcomes. <h3>Methods</h3> We searched PubMed, Embase and google scholar databases through entering combinations of search terms: "heart failure" [mesh] OR "heart failure" in the title and abstract AND symptom in the title" for articles published between 2016 and 2020. Of 495 matches, we excluded articles that did not mention HF in the title, did not mention individual symptoms in the abstract, or were focused on validation of instruments, symptom perception, or relationship of scores of instruments and outcomes. We selected 132 final articles and identified symptoms that were frequently described as part of HF research or evaluated as outcome measures. We then asked 15 patients with HF to review the list of symptoms and select the ones most bothersome in connection with their experience of the disease. Lastly, we had six clinicians review the symptoms identified by the patients and weigh in on their importance from clinician perspective. <h3>Results</h3> Among 43 symptoms identified in the 132 articles, we selected 13 that were mentioned in more than four articles (see Figure). Fifteen patients with HF ranked the 13 symptoms by how bothersome they were. The top seven symptoms ranked by patients were dyspnea, depression, fatigue, sleep disturbance, edema, pain and cognitive alterations. Depression, sleep disturbance and pain were three symptoms that are not routinely assessed. These three symptoms have also been shown as risk factors for negative outcomes such as poor quality of life, lower functional status, and unplanned healthcare use. <h3>Conclusions</h3> We present symptoms ranked by patients with HF according to burden. Depression, sleep disturbance and pain were important symptoms that in particular may require better assessment, monitoring and treatment.