Background/Significance: Heart failure patients have high mortality, co-morbidity, hospitalization rates, costs and numerous recommendations to follow. Non-cardiac pain is common and an additional compounding problem as it decreases heart failure (HF) patients’ ability to follow recommendations, decreases quality of life and increases the likelihood of being hospitalized. When depression is combined with HF and pain, patients are even less able to follow recommendations, treatment plans, and self-care behaviors.
Exercise is an important, low-cost intervention for pain that has considerably fewer adverse effects/interactions than pharmacologic therapies. Given the low rates of participation in exercise and the many barriers that discourage exercise participation, an essential first step is to establish current physical activity levels and how pain may further influence potential engagement in exercise programs.
Objectives: To characterize and describe: the experience of pain, pain management, the self-reported physical activity level including relationships between pain intensity, pain interference, total activity time, sitting time, perceptions of exercise, and depression, in older depressed HF participants.
Methods: This prospective cross-sectional study analyzed data from 62 participants with depression and Class II-IV HF. Data from the Brief Pain Inventory, Rand 36, International Physical Activity Questionnaire, Beck Depression Inventory II, and Exercise and Pain Management Questionnaire were used in the analysis.
Results: The majority of depressed HF patients had moderate to severe pain intensity and interference and no differences were found in demographics between those who had pain and those who didn’t. Depression level did not have an additional impact on pain intensity or pain interference. Non-pharmacological treatments were severely underutilized. The majority of participants think exercise will be helpful to treat their pain. The most common barriers to exercise for depressed HF patients include: shortness of breath 72%, having no one to exercise with 59%, fatigue 56%, other health conditions 56%, and the weather is too hot or too cold 55%. Those who had higher pain intensity, pain interference, or depression scores were not more likely to say exercise would be unhelpful than those with lower scores. Lastly, the majority would like to be more physically active.
Conclusion: The prevalence of pain reported by this sample, combined with the diverse pain locations, reliance on medications that are well-known for having untoward side-effects in this population, and generally poor treatment responses reported, make it clear that thorough pain assessment and additional pain treatment strategies are needed to decrease the impact of pain on this population. Findings suggest that depressed patients with HF believe exercise would be helpful to treat their pain and would also like to be more active. Decreasing sitting time and increasing light activity levels hold promise to improve pain and depression symptoms. Interventions to increase physical activity levels that are acceptable to depressed HF patients need to be identified and offered as treatment options, including referral to cardiac rehab as an important starting point for individualized support and education that may increase long-term adherence.