Pain characteristics in patients attending an outpatient heart failure clinic: A descriptive prospective study

BACKGROUND: Pain is common in heart failure (HF) and predicts worse outcomes, but inadequate characterization compromises optimal care. OBJECTIVES: To describe pain in patients with HF attending an outpatient program following an acute HF event, to assess changes in pain before and after the outpatient HF program, and to explore factors associated with pain. METHODS AND RESULTS: We used a prospective observational study design, where patients completed questionnaires at first consultation, and after 6 months. The questionnaires included items from validated pain questionnaires. Clinical parameters and Health-Related Quality of Life (HRQoL) were retrieved from medical records and the Norwegian Heart Failure Registry. In total 128 patients (26.6% female) were included. The prevalence of pain was 63.3% and 73.1% at baseline and follow-up respectively. Moderate to severe pain intensity was reported by 31.2% at baseline and 28.8% at follow-up. Breakthrough pain (BTP) and symptoms of neuropathic pain were common. Although HRQoL and objective HF parameters improved over the 6-month study period, pain outcomes showed an overall non-significant trend towards deterioration. Pain intensity in the last 24 h was associated with female sex, higher New York Heart Association functional class, depression, and poor HRQoL. Pain was most commonly reported in the lower extremities. CONCLUSIONS: Pain, including symptoms of neuropathic pain and BTP, was highly prevalent in patients with HF at both baseline and follow-up, highlighting its erratic nature. The findings suggest that its origins may extend beyond HF itself and underscore the need for more comprehensive and targeted approaches to pain management.