Background: 

Pruritus is one of the most oppressive symptoms, profoundly impairing quality of life (QoL). Previous studies identified pruritus as a frequent symptom in chronic heart failure (CHF) patients. Nevertheless, the nature of pruritus in CHF patients and its risk factors have not been defined yet. 

Methods: 

For this monocentric, prospective cohort study, CHF patients were recruited and surveyed by means of a questionnaire to assess comorbidities, CHF symptoms, and drug intake. An additional questionnaire evaluated pruritus symptoms. Detailed medical histories including laboratory test results were retrieved from patient files for all participants.

Results: 

We evaluated data from 550 CHF patients. Of those, 25.3% reported pruritus to occur frequently (3- 5 times per week), often (1- 2 times per week), or daily. Patients of higher NYHA classes (NYHA III + IV) (31.2%) experienced pruritus significantly more in comparison to lower NYHA classes (NYHA I + II) (21.1%, p=0.024). Patients with pruritus reported more concomitant stasis dermatitis (p=0.016) and chronic lung disease (p=0.011), but less dyslipidemia (p<0.0001). Other cardiologic parameters, laboratory values reflecting liver, kidney and thyroid function, as well as medical therapies were not different in patients with and without pruritus. Multivariate logistic regression analysis incorporating all identified parameters significantly associated with pruritus in univariate logistic regression analysis (age, NYHA class, leucocyte count, hemoglobin level, concomitant dyslipidemia, lung disease) demonstrated that only NYHA class (p=0.022, OR 1.55, 95% confidence interval [CI], 1.09 to 2.20) and elevated leukocyte count (p=0.013, OR 1.11, 95% CI, 1.02 to 1.21) remained significantly associated with pruritus in CHF patients.

Conclusions: 

Pruritus in patients with chronic heart failure is associated with clinical signs of heart failure severity and inflammation potentially reflecting impaired skin microcirculation or -homeostasis in advanced heart failure.