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

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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.

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Funding

Dr. Scott L. Hummel is supported by NIH/NHLBI K23-HL109176.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Craig M. Alpert & Scott L. Hummel

  2. Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA

    Michael A. Smith

  3. Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA

    Michael A. Smith

  4. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Scott L. Hummel & Ellen K. Hummel

  5. Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA

    Ellen K. Hummel

  6. University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA

    Ellen K. Hummel

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  1. Craig M. Alpert
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Correspondence to Ellen K. Hummel.

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None of the authors have conflicts of interest relevant to this manuscript. Dr. Scott L. Hummel is a site principal investigator for Novartis and Pfizer clinical trials and receives research funding from PurFoods, LLC.

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Alpert, C.M., Smith, M.A., Hummel, S.L. et al. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Fail Rev 22, 25–39 (2017). https://doi.org/10.1007/s10741-016-9581-4

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