chronic pain in chronic heart failure: a review article

heart failure (hf) is one of the main causes of death and disability in the world. the prevalence of hf in developed countries is between 1% and 2% of the adult population and approximately between 6% and 10% in the elderly, giving rise to high costs of care and treatment. indeed, in the united states, the direct and indirect costs exceeded 23 billion dollars in 2002.  hf is typically characterized by periods of acute symptoms followed by returns to nearly asymptomatic periods. as dyspnea and fatigue are considered the signature symptoms of hf, other symptoms such as pain go unnoticed. awareness of the burden of pain, however, is growing in patients with chronic hf. the past 2 decades have witnessed remarkable technical headway in cardiology and many patients have survived despite the progressive impairment of their cardiovascular function. it is, therefore, of great value to investigate the prevalence and management of pain in patients with hf. to that end, we undertook a comprehensive search using the medline database for studies and guidelines on the subject of pain and hf and the complications and considerations and finally selected 65 studies for review.