Study On Symptom Clusters And Influencing Factors Of Acute Coronary Syndrome Based On Conceptual Modified Model Of Symptom Management

Objective:1.Describe the symptom experience of patients with acute coronary syndrome before diagnosis.2.Cluster analysis was used to identify the symptom clusters in patients with acute coronary syndrome.3.To analyze the factors affecting the severity of symptom clusters order to provide guidance for clinical implementation of individualized symptom management.Methods:This study adopts the inquiry sequential mixing method in the mixed method study,which includes two parts: phenomenological study in qualitative study and cross-sectional investigation in quantitative study.Part I,18 patients with acute coronary syndrome were interviewed by qualitative research method,and the data were analyzed by phenomenological analysis method.Part II,in the quantitative study part,210 patients with acute coronary syndrome who received interventional therapy in a Grade 3A Hospital of Taiyuan,Shanxi Province,were selected as the subjects of the study.The questionnaires included a-general information questionnaire(including information on sex,age,marital status,education,working status,occupation,monthly family income,type of health insurance and disease)、Mc Sweeney Acute and Prodromal Myocardial Infarction Symptom Survey、the Chinese version of the Acute Coronary Syndrome Response Index.Descriptive statistics were used to describe the general data of patients,the incidence and severity of symptoms(and symptom clusters);cluster analysis was used to count the types of symptom clusters;t tests and one-way ANOVA were used to analyze the influencing factors of the severity of each symptom clusters.Results:1.Qualitative studiesFour themes have been concluded:(1)symptom perception: disease can be predicted,symptom experience is diverse and disease is easy to be ignored;(2)symptom evaluation:correct evaluation and evaluation of deviation:(3)symptom coping: self-coping and family-society support 2 sub-themes;(4)reflection of symptomexperience process: medical behavior and lack of awareness of diseases 2 sub-themes.2.Quantitative studies(1)Patients with acute coronary syndrome have 3 ~ 15 symptoms during the prodromal period.The top five with a high incidence were extremely weak,abnormal fatigue(62.86%,1.74±0.67),chest pain or discomfort(47.62%,1.31±0.46),anxiety(43.33%,1.31±0.46),shoulder pain or discomfort(24.76%,1.42±0.53).There are 3~19symptoms in patients with acute coronary syndrome.The top five with high incidence were chest pain/discomfort(79.52%,2.12±0.66),extreme burnout,abnormal fatigue(68.10%,2.17±0.81),cold sweat(67.62%,2.18±0.83),shortness of breath/dyspnea(53.81%,2.15±0.82).Patients with acute coronary syndrome have 2 ~ 14 symptoms after interventional therapy.The top 5 patients with high incidence were chest pain/compression/chest tightness(26.92%)and chest discomfort(dullness),burning,heating,palpation(16.35%),shortness of breath/dyspnea(19.23%),palpitations/heart rate acceleration(15.38%),arm or shoulder pain(3.37%).(2)In this study,six symptom clusters and one single symptom were obtained by systematic cluster analysis of symptoms in three periods,which were chest discomfort and emotional symptom cluster,cardiopulmonary related symptom cluster,typical symptom cluster,atypical symptom cluster,chest discomfort symptom cluster,cardiopulmonary related symptom cluster and single symptom extreme fatigue,abnormal fatigue.Among them,chest discomfort and emotional symptom clusters include chest pain or discomfort,anxiety,sleep disorders;cardiopulmonary related symptoms clusters include shoulder pain or discomfort,cough,shortness of breath/sitting breathing,heart rate acceleration of appetite loss;typical symptom clusters include chest pain/discomfort,shortness of breath /dyspnea,cold sweat,extreme burnout,abnormal Fatigueatypical symptom cluster include dizziness/syncope,shoulder pain/discomfort,upper limb pain/discomfort,heart rate acceleration,nausea/vomiting.Chest discomfort symptom cluster include chest pain/compression/chest tightness,chest discomfort(dull 、 burning fever 、 tenderness);cardiopulmonary related symptom cluster include shortness of breath/dyspnea,palpitations/ heart rate acceleration.(3)Sex,age,working status,hypertension,diabetes,bad habits(drinking/smoking),type of diagnosis of ACS patients,average monthly household income and medical reimbursement method(P<0.05)had an effect on the severity of the symptom cluster of ACS patients.Conclusion:1.Patients with acute coronary syndrome experience multiple symptoms and can aggregate into symptom clusters.It provides a theoretical basis for the study of symptom cluster in patients with acute coronary syndrome.Medical staff can carry out effective symptom management from symptom clusters,and improve the recognition of disease in patients with acute coronary syndrome from the point of view of symptom clusters.2.It can be seen from this study that the severity of symptom clusters in patients with acute coronary syndrome ACS patients is affected by sex,age,working status,hypertension,diabetes,bad habits(drinking/smoking),type of diagnosis of ACS patients,average monthly income of family and medical reimbursement.It provides a certain basis for taking targeted measures to manage the symptom cluster of patients with acute coronary syndrome in the future.Medical staff can intervene in sexual nursing from the angle of influencing factors.