The prevalence of congestive cardiac failure (CCF) is increasing as a result of improved survival of myocardial infarction, and increases in prevalence with increasing age . Lower urinary tract symptoms, including urgency, frequency, and nocturia, are also highly prevalent in older adults . National and international guidelines, as well as custom and practice, suggest assessment and treatment of CCF in older adults with LUTS , but the evidence that treating CCF can impact LUTS is sparse.
This scoping review aimed to review and summarise existing knowledge regarding LUTS in patients with heart failure and to identify research gaps.  To our knowledge this is the first formal review of this topic.

We performed a scoping review, based on the methods of Arksey and O’Malley, to search Ovid, Medline, and Scopus using a combination of key words (“urine OR urinary frequency, urine OR urinary urgency, urine OR urinary incontinence, overactive bladder (OAB), nocturia, dysuria or lower urinary tract symptoms (LUTS) AND heart failure (HF) or congestive cardiac failure (CCF) or cardiac failure”).  We included studies which broadly related to lower urinary tract symptoms in patients with heart failure and excluded any non-human studies, commentaries, editorials, studies not published in English and any studies published before 1986.  Articles titles were reviewed by a single author, and the abstracts of those meeting the criteria were reviewed by two authors. Those which either reviewer felt met criteria were read in full by both authors and included in the analysis.  A scoping review, rather than systematic review or meta-analysis was preformed due to the lack of rigorous clinical trials and allowed us to map the current research with the aim of identifying evidence gaps and research opportunities.

The initial search identified 2780 citations of which 34 articles which met our inclusion criteria: 24 were original articles and 10 review articles, as shown in Figure 1.  Key themes were identified within the selected studies with existing knowledge focused in seven key areas (Table 1); 1. Epidemiology of LUTS in heart failure, 2. Causes of LUTS in heart failure, 3. Impact of sex, 4. Impact of medications, 5. Link between severity of heart failure and LUTS, 6. Impact of nocturia on sleep, 7. Management options.

The published evidence regarding the link between LUTS and heart failure is limited, largely comprising small scale studies which are observational in nature.  The overarching conclusion from this scoping review is that the evidence is patchy making it difficult to draw robust clinical conclusions.  Estimates of prevalence, the pathophysiology, cause and treatment options of LUTS in patients with heart failure remain unclear. The paucity of data, and the potential role of LUTS in discouraging concordance of patients with their heart failure treatments, makes this an important area for future research, particularly as the studies give the impression that these symptoms are relatively common, which may lead to an underestimation by those treating CCF of the impact on LUTS and patients’ quality of life.  To ensure patients with heart failure and co-existing LUTS receive adequate symptomatic and life-extending treatments, without increased co-morbidity and side effects, there is a need for long-term studies tracking the prevalence, causes of, and changes in LUTS following a diagnosis and treatment of heart failure, as well as possible management strategies.

Clinical experience and practice suggests that CCF and LUTS interact.  However, there is no good evidence to explain this interaction, its extent or the optimal management strategies of these urinary symptoms in patients with heart failure and vice versa.  Despite this lack of data, health professionals interacting with patients with heart failure should be aware of the potential implications of the diagnosis and treatment options on urinary symptoms as this may impact quality of life and medication compliance.

Anh LB et al., Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011 Jan; 8(1): 30–41.
Coyne, K.S., et al., The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int, 2008. 101(11): p. 1388-95
Wagg, A., et al., Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence. Neurourol Urodyn, 2015. 34(5): p. 398-406.