Abstract 11179: Exploring the Implications of Pain Symptoms in Patients With Heart Failure

Introduction:Patients with heart failure (HF) often have pain that worsens quality of life and may also contribute to the progression of HF. However, limited data exist describing the relationship between pain and HF outcomes.Methods:Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a randomized controlled trial evaluating the safety and efficacy of an exercise training program for patients with HF with reduced ejection fraction (HFrEF). Patients? pain severity was assessed at baseline and follow-up visits with a 6-point Likert scale. Patients were grouped by their self-reported baseline pain severity: no pain, very mild/mild, moderate, and severe/very severe. Baseline characteristics by pain severity were compared using trend tests and the association of pain severity with clinical outcomes (mortality and hospitalization) was assessed using multivariate adjusted analyses.Results:At baseline, 2310 (99.1%) patients completed pain assessments: 528 (22.9%) reported no pain, 1059 (45.8%) very mild/mild pain, 576 (24.9%) moderate pain, and 147 (6.4%) severe/very severe pain. Those with the greatest pain were more likely to be younger, be female, have a history of depression, have non-ischemic HF, have a higher New York Heart Association functional class, and have higher Canadian Cardiovascular Society angina scores (all P<0.05). As pain severity increased, quality of life measurements (EuroQoL-5 Dimension questionnaire and Kansas City Cardiomyopathy Questionnaire) significantly worsened (both P<0.0001) and depressive symptoms (Beck Depression Inventory-II) significantly increased (P<0.0001). Compared to those who reported no pain at baseline, patients who reported severe/very severe pain had significantly higher all-cause death or hospitalization (adjusted hazard ratio 1.42, 95% confidence interval 1.11-1.83, P=0.01).Conclusion:Greater pain severity was associated with worse quality of life and clinical outcomes in patients with HFrEF. Pain warrants further study to elucidate its relationship with HFrEF and to potentially elevate its priority in the treatment plan for patients with HFrEF.