CV Symptoms Deserve More Attention, Quantification: AHA Statement

Symptoms associated with cardiovascular disease often overlap depending on the condition, vary by sex, drive healthcare utilization, and are a major contributor to patient quality of life, according to a new scientific statement endorsed by the American Heart Association (AHA). As such, the authors argue, symptoms deserve greater attention by both patients and providers.

“Typically, people want objective metrics to see how a patient is doing—so blood pressure, their oxygen saturation, and so forth,” lead author Corrine Y. Jurgens, PhD, RN, ANP (Boston College School of Nursing, MA), told TCTMD. “But we know that symptoms affect quality of life, and they also can predict clinical events, so quantifying them in a reliable and valid way is really important to support quality care.”

For the statement, published online today in Circulation, Jurgens and colleagues outline how symptoms can often change over time—through a matter of months for some diseases and years for others—and can vary in intensity. There are especially well documented instances where symptoms can vary by sex for conditions like ACS, heart failure, aortic valve disease, stroke, AF, and peripheral arterial disease.

“Symptoms also drive healthcare use and are a major contributor to broad patient-reported outcomes such as quality of life in chronic CVD,” they write, adding that symptoms have been relied upon less as endpoints in clinical research compared with hard outcomes like death or hospitalization.

Subjective but Quantifiable

Because identifying and tracking symptoms can be so subjective, Jurgens said this is all the more reason why they need to be paid more attention. For example, “There are some patients who do not think that fatigue is a symptom, and it is a significant symptom for a variety of cardiovascular diseases,” she said. Other patients might discount their symptoms, as has been observed in sudden cardiac arrest patients.

Providers should take the time to quantify symptoms in a “reliable and valid way and tracked over time versus just present or absent,” Jurgens continued. “That might signal a worsening of their condition.”

She also pointed to the example of depression—something that’s been linked to worse mortality outcomes in CAD patients—as a condition that takes that extra step to assess, because “just looking at a patient, you do not know if they have depressive symptoms or not. You really have to screen [and establish a baseline]. . . . Depression and cognition can affect the ability to detect a change in their symptoms. So tracking that over time is also critical.”

Jurgens said they plan to update the statement as more research comes out. Specifically, she pointed to a supplemental document that lists all of the currently validated measures for symptoms. “We don't have clear cut points of when people are in trouble or not . . . in each cardiovascular disease,” she said. “That kind of work is what we need to continue to do.”

Also, since symptoms usually appear “in clusters,” Jurgens said she would like to see future research look at how they typically group in different populations across diseases. This is important, she continued, because “I could put two [heart failure patients] in front of me with the exact same objective metrics of ejection fraction and other measures that we use to see what their health status is like, and they could have a different presentation in terms of symptoms. Those differences are important to track over time.”

These data might have clinical relevance for how often patients with low, medium, and high symptom burdens need to be evaluated. “Typically, stable patients with heart failure are seen every 90 days,” Jurgens said. “For some patients, that's far too long. If we could figure out who needs more-frequent oversight or who can be targeted for improving self-care, that would also improve outcomes.”