Symptoms persist in patients hospitalized for heart failure

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A large percentage of patients hospitalized for heart failure at Yale-New Haven hospital had symptoms such as anxiety and pain that are typically not associated with the condition, according to a prospective study.

The researchers also found that patients often did not have improvements in symptom severity after getting discharged. They reported their results online in JAMA Internal Medicine on Aug. 17.

The study, which was conducted from Aug. 21, 2013, through Dec. 31, 2014, included 91 patients. Patients enrolled within two days of hospital admission. They were asked about their symptoms during their hospitalization via the Edmonton Symptom Assessment scale and were interviewed via telephone one week after discharge.

The mean time for the baseline interview was 2.5 days following hospital admission, while the mean time for the follow up interview was 9.9 days after discharge. The mean age was 71.5, and 52 percent of patients were females.

From baseline until the follow-up period, 58 percent of patients had no improvement in fatigue, 42 percent had no improvement in drowsiness, 42 percent had no improvement in dyspnea, 41 percent had no improvement in anxiety and 41 percent had no improvement in pain.

The researchers mentioned a few possible explanations for why patients’ symptoms did not improve. They noted that older patients with heart failure have comorbid conditions that may complicate managing the symptoms, while physicians may not thoroughly assess symptoms such as pain, anxiety, depression and fatigue. They also said that hospitals and health systems are pressured to reduce their length of stays for patients, so they may discharge them too soon.

Although the researchers noted that palliative care may improve outcomes and lead to fewer 30-day readmissions, only 22 percent of the patients were familiar with the concept. After the researchers explained palliative care, 68 percent of patients said they would be interested in the services.

Previous studies found fewer than 10 percent of patients with heart failure receive palliative care, according to the researchers.

“The progressive nature of [heart failure], coupled with high mortality rates and poor quality of life, make it suited for the incorporation of palliative care,” the researchers wrote. “Given that symptoms frequently drive health care use, early integration of palliative care may reduce readmissions.”