Heart failure guidelines focusing on the wrong symptoms

By Nicola Garrett

5 Apr 2018

Current heart failure guidelines focus on improving the physical symptoms of the disease but new research shows they may be on the wrong track by ignoring co-morbidities.

An analysis of data from the Swedish Heart Registry involving 10,575 heart failure patients found that non-cardiovascular comorbidities were associated with higher overall symptom burden and more severe symptoms than cardiovascular comorbidities.

Anxiety or depression had the strongest association with functional limitations (OR 10.03, CI 5.16 to 19.50) and patient-rated health score (mean difference -18.68, CI -23.22 to -14.14), found the study published in  PLOS Medicine as part of a special series on cardiovascular disease and multimorbidity.

According to the researchers led by Claire Lawson from the Diabetes Research Centre, at Leicester University in the UK it has long been recognised that psychosocial factors such as anxiety and depression are infrequently assessed or treated in HF clinical practice.

“…only a minority of HF patients with depression [are] prescribed antidepressant drugs or counselling or referred for cognitive behavioural therapy. Pain is also poorly managed in HF patients, with relatively low use of analgesics or opioids,” they wrote.

In order to improve the health-related quality of life of heart failure patients  guideline-driven care needs to include optimal management of the most prevalent non-cardiovascular comorbidities and routine management of pain and anxiety or depression,  the researchers said.

“To provide individualised patient care, guidelines need to better align symptoms with the cardiovascular and non-cardiovascular status of the patient,” they concluded.

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