title: An evaluation of the prevalence and severity of pain and other symptoms in acute decompensated heart failure.
abstract: BACKGROUND
  Heart failure is characterized by recurrent decompensations and persistent symptoms that decrease quality of life. Shortness of breath and fatigue are commonly identified symptoms but there is limited data on pain in heart failure patients. The Edmonton Symptom Assessment System (ESAS) was used to identify the prevalence and severity of pain and other symptoms experienced by patients with acute decompensated heart failure.
  
  
  METHODS
  This is a cross-sectional study that evaluated patients with a history of chronic heart failure admitted to the hospital with acute decompensated heart failure. A standardized questionnaire (ESAS) was administered to patients within 24 hours of hospital admission. Exclusion criteria included patients <18 years of age, admission for a noncardiac reason, active malignancy, history of chronic pain, outpatient chronic pain medication use, and those actively followed by the palliative care service.
  
  
  RESULTS
  One hundred patients, 67 males, with a mean age of 58 ± 17 years were recruited. The mean ejection fraction (EF) was 37%± 18%. Sixty patients (60%) reported pain of any degree. Patients with lower EF (≤ 40%, n=61) reported significantly higher pain scores (4.1 ± 3.6) compared to patients with higher EF (>40%, n=36, 2.7 ± 3.4, p<0.05). Tiredness, shortness of breath, and decreased well-being were the most severe symptoms with mean scores of 6.3 ± 2.8, 6.1 ± 3.1, and 5.7 ± 2.6, respectively.
  
  
  CONCLUSIONS
  Pain is a common, underrecognized symptom in patients with chronic but acute decompensated heart failure. Decreased well-being, shortness of breath, and tiredness are the most common and severe symptoms in patients with chronic heart failure, regardless of ejection fraction.
authors.affiliation: Cedars-Sinai Heart Institute and Palliative Care Program , Los Angeles, California 90048, USA.
authors.forename: Ankit B
authors.initials: AB
authors.lastname: Shah
authors.forename: Dioma U
authors.initials: DU
authors.lastname: Udeoji
authors.forename: Afshan
authors.initials: A
authors.lastname: Baraghoush
authors.forename: Parag
authors.initials: P
authors.lastname: Bharadwaj
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology; D014481:United States / Q000453:epidemiology