Emotional Symptom Burden in Patients Following Heart Failure Hospitalization Discharge

a senior female patient sits and chats to a female doctor who we see from behind . She is listening to her symptoms
Investigators examined the determinants, details, and prognostic significance of heart failure symptom burden in hospitalized patients.

A prospective study found that many patients with heart failure (HF) experience clinically relevant emotional symptoms at discharge. These findings were published in ESC Heart Failure.

Patients (N=294) with a primary diagnosis of HF hospitalized at the National Organization Kyoto Medical Center in Japan between 2019 and 2021 were prospectively enrolled in a registry. For this study, patients were evaluated for symptom burden using the Integrated Palliative care Outcome Scale (IPOS) at admission and discharge.

Patients were aged mean 77.5±12.0 years, 57% were men, BMI was 24.6±5.5, and 42% had acute on chronic HF. Patients were evenly split between higher (³20 points; n=145) and lower (£19 points; n=149) IPOS scores.

Patients with higher IPOS scores were younger (P =.008); more had a history of depression (P =.029); used antidepression medication at admission (P =.041); and fewer used angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors at admission (P =.019).

During hospitalization, the IPOS score decreased from 19 points at admission to 13 points at discharge (P <.001). The top 5 symptoms at admission were shortness of breath, family anxiety, patient anxiety, weakness, and poor mobility. At discharge the most common symptoms were family anxiety, patient anxiety, depression, sharing feelings, and feeling at peace.

The symptom burden was observed to increase among nearly a third of patients (28%). The patients who worsened and improved in symptom burden had similar patient profiles, except patients who experienced worsening symptom burden were more likely to have chronic kidney disease (86% vs 74%; P =.041).

Despite the similar profile, patients with worsening burden were associated with a decreased event-free survival rate up to 500 days (P =.027), a higher cumulative incidence of mortality (23.9% vs 10.3%; P =.032), and an increased mortality risk (adjusted hazard ratio, 2.28; 95% CI, 1.02-5.09; P =.044).

The findings of this study may not be generalizable, as data were sourced from a single center.

“We revealed that multidimensional symptom burdens exist in hospitalized patients with HF, which cannot be predicted by HF disease severity,” the study authors wrote. “Further studies are warranted to investigate whether screening and intervention for multidimensional symptoms using validated scale like IPOS can improve the

quality of life in patients with HF.”


Hamatani Y, Iguchi M, Ikeyama Y, et al. Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients. ESC Heart Fail. Published online March 20, 2022. doi:10.1002/ehf2.13907