Acta Dermato-Venereologica 99-7CompleteContent | Page 15

679 SHORT COMMUNICATION Itch in Patients with Acute Heart Failure Małgorzata PONIKOWSKA 1 , Jan BIEGUS 2,3 , Robert ZYMLINSKI 2,3 and Jacek C. SZEPIETOWSKI 1 1 Department of Dermatology, Venereology and Allergology, and 2 Department of Heart Diseases Wrocław Medical University, ul. T. Chałubińskiego 1, PL-50-368 Wrocław, and 3 Department of Cardiology, Centre for Heart Disease, 4 th Military Hospital, Wroclaw, Poland. E-mail: [email protected] Accepted Apr 2, 2019; E-published Apr 2, 2019 Itch is a common and distressing symptom occurring not only in dermatological conditions but also in chronic systemic diseases (1). In heart failure (HF) – which is a complex clinical syndrome – underlying pathophysio- logies, course of the disease, coexisting comorbidities and medications – all tend to predispose patients to developing itch (2–5). Only a few studies investigated the occurrence of itch in HF, reporting a wide prevalence ranging from 10–40% (2–5). However, these studies used inconsistent definitions and different tools for itch evaluation, and included heterogeneous HF populations (2–5). Therefore, we set-up the prospective study among patients with acute HF, using standardized methods for itch assessment in order to investigate the prevalence of itch and explore the potential underlying causes. METHODS Study population The study population consisted of patients hospitalized with a diagnosis of acute HF (Heart Failure, as assessed by NYHA class III and IV on admission), prospectively included into the registry that runs in our institution. Inclusion criteria were: age ≥18 years; acute HF as the primary cause for hospitalization (6); patient’s written agreement to participate. Exclusion criteria for this analysis included: mental status changes preventing the patient from per- forming a detailed assessment of itch (see below); known severe renal or liver disease; history of chronic dermatological disease. After inclusion, detailed information on demographics, clinical history, comorbidities, previous therapies and physical findings was recorded. Standard laboratory assessment was performed using methods applied in our laboratory. The local ethics com- mittee approved the protocol (consent No KB-406/2015) and all subjects gave written informed consent. Evaluation of itch Itch assessment was performed in all patients once they were clinically stable and before hospital discharge using the following instruments: the visual analogue scale (VAS), numerical rating scale (NRS), and the 4-item Itch Questionnaire (7–10). Patients were asked to assess itch during the last 3 days. Various clinical features of itch, including exact location, quality and descriptors and the most common factors responsible for its aggravation or alleviation, were assessed (10). Dermatology Life Quality Index (DLQI) was applied to assess the impairment in quality of life, related to itch (11). Statistical analysis Continuous variables with a normal distribution were presented as means  ±  standard deviation (SD), variables with skewed distribu- tion as medians with upper/lower quartiles, categorized variables as numbers and percentages. The statistical significance of the dif- ferences between groups was assessed using: t-test, Mann-Whitney U-test or Chi 2 test, where appropriate. The associations between variables were tested using univariable and multivariable logistic regression models. The p < 0.05 was considered statistically signi- ficant. Statistical analyses were performed using the STATISTICA 12 (StatSoft, Inc, Tulsa, OK. 74104, USA). RESULTS Of 84 patients enrolled, 63 (75%) were men, with the mean age of 66  ±  13 years. Baseline clinical and labora- tory characteristics of the study population are presented in Table SI 1 . Fourteen patients reported history of itch (prevalence 17%): in 11 patients (79%) itch occurred during the last 3 days, whereas 3 (21%) reported a history of itch before the current hospital admission. We found the following characteristics in patients reporting itch: more severe HF symptoms on admission, need for inotropic drugs during the hospital stay, more frequent use of the novel oral anticoagulants before admission, higher serum bilirubin level (p < 0.05 in all comparisons) (Table SI 1 ). Characteristic of itch In the majority (n = 10, 71%) of patients itch was limited to a certain skin area, mostly lower and upper limbs (n = 7, 50%). Four (29%) patients reported itch of the lower legs and feet, which coincided with bilateral oedema. Six pa- tients (43%) experienced itch on a daily basis, 7 (50%) reported it as appearing a few times per week, 1 (7%) few times per month. Most frequently patients described itch-related sensations as tingling (n = 7, 50%), tweaking (n = 4, 29%), burning (n = 3, 21%) or stinging (n = 2, 14%). Itch was reported as being predominantly annoying (n = 9, 64%) or burdensome (n = 7, 50%). Itch was responsible for problems with falling asleep in 6 (43%) patients (none reported use of hypnotics). We did not observe any specific factors responsible for either aggravation or alleviation of itch: only 2 (14%) patients linked itch exacerbation with sweating and hot water; 3 (21%) its alleviation with cold water. None of the patients have ever received any specific therapy for this symptom. The mean  ±  SD severity of itch measured with VAS was 4.4  ±  2.8 points (mild–moderate in 10 (71%), severe https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3187 1 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3187 Acta Derm Venereol 2019; 99: 679–680