Background Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered. Objectives To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia. Design Cross-sectional, observational study. Settings In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States. Participants A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions. Methods Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward’s method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores. Results There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters. Conclusion Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.

Family members caring for HF patients with depressive symptoms had significantly higher levels of caregiving burden and worse quality of life compared to those caring for patients without depressive symptoms.

better HRQOL among older HF patients is the result, in part, of better psychosocial status. The major factor driving better HRQOL among older patients is a change with advancing age in expectations about what constitutes good HRQOL.

Background and Purpose Many patients with heart failure (HF) experience physical symptoms, poor health-related quality of life (HRQOL), and high rates of hospitalization. Physical symptoms are associated with HRQOL and are major antecedents of hospitalization. However, reliable and valid physical symptom instruments have not been established. This study, therefore, examined the psychometric properties of the Symptom Status Questionnaire-Heart Failure (SSQ-HF) in patients with HF. Method Data on symptoms using the SSQ-HF were collected from 249 Patients (age 61, 67% male, 45% in New York Heart Association functional class III/IV). Internal consistency reliability was assessed using Cronbach’s alpha. Item homogeneity was assessed using item-total and inter-item correlations. Construct validity was assessed using factor analysis and testing hypotheses on known relationships. Data on depressive symptoms (Beck Depression Inventory II), HRQOL (Minnesota Living with Heart Failure Questionnaire), and event-free survival were collected to test known relationships. Results Internal consistency reliability was supported: Cronbach’s alpha was .80. Item-total correlation coefficients and inter-item correlation coefficients were acceptable. Factor analysis supported the construct validity of the instrument. More severe symptoms were associated with more depressive symptoms, poorer HRQOL, and more risk for hospitalization, emergency department visit, or death, controlling for covariates. Conclusions The findings of this study support the reliability and validity of the SSQ-HF. Clinicians and researchers can use this instrument to assess physical symptoms in patients with HF.