Symptoms matter - symptom diversity and trajectory across different phases of heart failure: from diagnosis to end of life.

Abstract

Purpose of review: Heart failure is a complex, progressive and life-limiting condition that affects individuals beyond physical symptoms. Psychosocial and behavioural symptoms, such as anxiety, depression, cognitive impairment, and social withdrawal, substantially impact their quality of life. Despite increasing recognition of multidimensional symptom burden across heart failure trajectory, these non-physical symptoms are often under-recognised by clinicians and researchers. This review summarises current contemporary evidence on symptom experiences from diagnosis of heart failure through to end-of-life, highlighting key features along this continuum.

Recent findings: Understanding full symptom profile including physical, psychological, social, and behavioural dimensions is essential to improving symptom management and overall care. However, limited evidence exists on symptoms experienced prior to and during formal diagnosis of heart failure. While some studies identify classic symptoms, the broader spectrum, including symptom normalisation and behavioural adaptations, remains poorly understood. Variation in symptom perception across populations underscores the need for a more individualised and culturally responsive approach.

Summary: A systematic and person-centred symptom assessment strategy is critical, particularly during advanced and end-of-life stages of heart failure. Integrating under-recognised symptoms into routine care, through multidisciplinary collaboration, can improve outcomes, enhance care quality, and better support individuals and families throughout the course of the illness.