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Symptom Distress and Quality of Life in Patients with Advanced Congestive Heart Failure
Open accessAbstract
Little is known about the burden of illness associated with advanced congestive heart failure (CHF). Understanding the needs of this population requires further information about symptoms and other factors related to quality of life. We studied a convenience sample of 103 community-dwelling patients with New York Heart Association Class III/IV CHF. The primary outcome, quality of life, was measured with the Multidimensional Index of Life Quality. Potential correlates of quality of life included overall symptom burden (Memorial Symptom Assessment Scale, MSAS), including global symptom distress (MSAS Global Distress Index, GDI); psychological state (Mental Health Inventory-5); functional status (Sickness Impact Profile); spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality Scale); and co-morbid conditions (Charlson Comorbidity Index). Patients had a mean age of 67.1 years (SD=12.1); were mostly white (72.8%), male (71.8%), and married (51.5%); and had a mean ejection fraction of 22.3% (SD=6.8). The most prevalent symptoms were lack of energy (66%), dry mouth (62%), shortness of breath (56%), and drowsiness (52%). Pain was reported by about one-third of patients. For each of these symptoms, high symptom-related distress was reported by 14.1%-54.1%. Quality of life was moderately compromised (Multidimensional Index of Life Quality composite, median=56, possible range 12-84). Impairment in quality of life was strongly associated with global symptom distress (MSAS GDI; r=0.74, P<0.001); burden of comorbid conditions (r = -0.32, P=0.002), female sex (r=-0.22, P=0.03), functional impairment, particularly psychological impairment (r=-0.55, P<0.001), and poorer psychological well-being (r=0.68, P<0.001). In multivariate analyses, impairment in quality of life was significantly related to high symptom distress, poorer psychological well-being, and poor functional mobility (R2=0.67; P=0.002 for all). Distressful symptoms related to impaired quality of life included lack of energy (P=0.04), irritability (P=0.03), and drowsiness (P=0.02). Community-dwelling patients with advanced CHF experience numerous symptoms, significant symptom distress, and a compromised quality of life. Overall quality of life was strongly associated with symptom distress, psychological well-being and functional status. A focus on ameliorating prevalent physical symptoms and psychological distress, along with supportive measures that promote functional mobility, may lead to an improvement in the overall quality of life in this patient population.
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“Despite over 40% of CHF patients complaining of cough, it remains a symptom that is missed from commonly used tools such as the NYHA scale. 3 , 11”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [3]
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Cites
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Bernardo, B. C., Weeks, K. L., Pretorius, L., & McMullen, J. R. (2010) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2010.04.005 · Cited by 920
Jaarsma, T., Beattie, J. M., Ryder, M., Rutten, F. H., McDonagh, T., Mohacsi, P., Murray, S. A., Grodzicki, T., Bergh, I., Metra, M., et al. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp041 · Cited by 542
Palliative Care in Congestive Heart Failure
Goodlin, S. J. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.02.078 · Cited by 386
Symptom Distress and Quality of Life in Patients with Advanced Chronic Obstructive Pulmonary Disease
Blinderman, C. D., Homel, P., Billings, J. A., Tennstedt, S. L., & Portenoy, R. K. (2009) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2008.07.006 · Cited by 316
Self-citationSymptom burden in heart failure: assessment, impact on outcomes, and management
Alpert, C. M., Smith, M. A., Hummel, S. L., & Hummel, E. K. (2017) · Heart Failure Reviews · doi:10.1007/s10741-016-9581-4 · Cited by 304
Metadata
- Authors
- Blinderman, C. D., Homel, P., Billings, J. A., Portenoy, R. K., & Tennstedt, S. L.
- Affiliations
- Harvard University (US)
- Mount Sinai Beth Israel (US)
- New England Research Institutes (US)
- Corresponding author
- Blinderman, Craig D.
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 35
- Issue
- 6
- Pages
- 594-603
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC2662445
- OpenAlex
- W2055107847
- Cited by
- 318
- References
- 33
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 15 · 2023: 18 · 2022: 13 · 2021: 19 · 2020: 19 · 2019: 20 · 2018: 12 · 2017: 27 · 2016: 30 · 2015: 24 · 2014: 21 · 2013: 15 · 2012: 25
- FWCI
- 11.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Nursing Research (R01NR005154, NR05154)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- congestive heart failure, advanced heart failure, quality of life, symptom distress, symptom burden, psychological well-being, functional status, comorbidities, spirituality, lack of energy, dyspnea, sleepiness, pain, community-dwelling patients, disease burden, sex differences, functional mobility, Memorial Symptom Assessment Scale, Sickness Impact Profile
- MeSH terms
- Aged, Cardiomyopathy, Dilated, Female, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Regression Analysis, Comorbidity, Sickness Impact Profile, Spirituality
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