Symptom burden in heart failure: assessment, impact on outcomes, and management.
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.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Craig M
CM
Alpert
Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.|Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA.
Michael A
MA
Smith
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.|VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Scott L
0000-0002-0924-3135
SL
Hummel
VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. ehummel@med.umich.edu.|Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA. ehummel@med.umich.edu.|University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA. ehummel@med.umich.edu.
Ellen K
EK
Hummel
D019468:Disease Management; D018450:Disease Progression; D019317:Evidence-Based Medicine / Q000379:methods*; D014943:Global Health; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D015995:Prevalence; D012648:Self Care / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
Heart failure; Palliative care; Quality of life; Supportive care; Symptoms