Background Individuals with heart failure particularly in the palliative phase of their illness experience a range of symptoms that affect their health-related quality of life. However, there is a lack of comprehensive symptom assessment with people with heart failure.

Aim To investigate European Society of Cardiology (ESC) Guidelines’ ‘typical’ and ‘less typical’, and ‘non-ESC’ symptoms associated with heart failure, and ESC typical and less typical symptoms regarding setting, age, and sex.

Methods A mixed-method systematic review and narrative synthesis. Systematic search was carried out in six electronic databases. Quality was assessed using Joanna Briggs Institute (JBI) critical appraisal checklists. Symptoms were grouped into typical and less typical, and non- guidelines symptoms. Differences in typical and less typical symptoms were investigated in hospital versus community settings, <65 versus ≥65 years old age, and men versus women.

Results 37 papers (26 quantitative, 8 qualitative and 3 mixed-method research) were included. 62% of participants were male. Mean age was 66 (48–82). Participants in 36 studies reported at least one of 6 typical, whereas less typical (n=10) and non-Guidelines n=37) symptoms were observed in 35 and 37 studies, respectively. Most observed symptoms of each group were: Breathlessness (typical-78%, n=3659); cough (less typical-48%, n=3450); and lack of energy (non-ESC-69%, n=1758). Less typical symptoms (cough, wheezing, palpitation, and dizziness) were different between hospital and community-dwelling cohorts. Typical symptoms (orthopnoea, paroxysmal nocturnal dyspnoea, and swelling) were higher in cohorts ≥65 years old age. Due to the paucity of women’s perspectives in studies, there was little information available to compare the symptom experiences of men and women.

Conclusion A comprehensive individual symptom assessment will be required to provide more focused and person-centred care. Thus, clinical management guidelines should include the full spectrum of symptoms in different phases of heart failure (especially, palliative and end of life care).

PROSPERO-ID:CRD42020185786