Symptom clusters of heart failure

Abstract

Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N=687) was conducted. The sample was 51.7% female, mean age 71±12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of 9 items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact.

A preliminary investigation of symptom pattern and prevalence before and up to 6 months after implantation of a left ventricular assist device

“…This claim is supported by significant relationships among the variables studied (symptoms), with correlation coefficients ranging from r = -0.3 (fatigue and sleep disturbance) to 0.8 (anxiety and depression) at p \ 0.05, warranting further investigation. In symptom cluster studies involving moderate to advanced HF patients, investigators found that anxiety (worrying) and depression are clustered within emotional/cognitive symptoms whereas fatigue and sleep disturbance clustered as physical symptoms [20,21]. Thus, our results support the need for more symptom-cluster research in HF and mechanical circulatory support.…”

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

“…Some data are available on symptom clusters in patients with HIV disease (10,11), chronic kidney failure and endstage renal disease (15,16), COPD (12,13), osteoarthritis (45), rheumatoid arthritis (46), and heart failure (14). Similar to studies in oncology, the occurrence of symptom clusters in these chronic conditions is associated with decrements in functional status and QOL, as well as increased health care utilization and mortality.…”

“…While the psychiatric literature provides excellent examples of the use of hierarchical cluster analysis to define subgroups of patients within a diagnostic subgroup (for examples, see 5-7) or as diagnostic criteria (for examples, see 8,9), the majority of the research on symptom clusters in patients with chronic conditions was conducted with oncology patients. However, an emerging body of evidence suggests that symptom clusters occur in patients with a variety of chronic conditions (eg, HIV disease [10,11], chronic obstructive pulmonary disease [COPD] [12,13], heart disease [14], end-stage renal disease [ESRD] [15,16]). Nonetheless, research on symptom clusters is extremely limited.…”

A Randomized Controlled Trial of Listening to Recorded Music for Heart Failure Patients

“…125,126 Somatic perception of HF symptoms They will be evaluated with the Heart Failure Somatic Perception Scale (HFSPS). 12 The HFSPS is a questionnaire consisting of 18 items that measure how much specific HF symptoms were bothersome for a patient during the last week. Each item corresponds to a symptom (eg, breathing problems or fatigue).…”

“…9 In fact, a large proportion of HF patients, between 50% and 85%, remain in the more severe functional classification within the New York Heart Association class, even after progressive improvements in pharmacological treatments. [10][11][12] Therefore, while pharmacological therapies may improve heart function, they may be only partially effective at reducing symptoms. Persistence of HF symptoms is not only a criterion for hospitalization or discharge 13 and an important predictor of survival 14 but can also reduce QOL 15 and influence decision making related to treatment.…”