Changes Of Heart Failure Symptom Clusters During The Course Of Disease:a Longitudinal Study

Background:Multiple, concurrent symptoms of heart failure (HF) adversely affect patients’functional status and quality of life. Moreover, patients have considerable difficulty in recognizing and responding to symptoms and delay for seeking care. Identification of symptom clusters of heart failure and their transformation through the progression of disease might provide a basis for continuing care and help patients better recognizing the changes in condition. However, little is known about the changes of symptom clusters during the course of disease.Objectives:(1) To identify symptom clusters of heart failure patients using cluster analysis. (2) To explore changes of HF symptom clusters before admission to 3 months and 6 months after discharge. (3) To explore the impact of symptom clusters before admission on cardiac re-hospitalization and death.Methods:A convenient sample of 200 HF patients from one cardiology hospital in Beijing were recruited in this longitudinal study. The Chinese version of Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF) was utilized to collect data. Patients had been followed up for 6 months to collect data about changes of symptom clusters at different time periods (before admission,3 months after discharge,6 months after discharge). Symptoms with incidence rates above 15% were chosen to be clustered. Survival analysis was used to evaluate the impact of symptom clusters before admission on cardiac re-hospitalization and death.Results:(1) HF symptoms before admission had been divided into 4 clusters:emotional and digestive cluster, ischemic cluster, weary symptom cluster, and congestive edema cluster. Symptoms at 3 months and 6 months after discharge fell into 2 clusters:sickness cluster and weary cluster. Sweats had not been included in sickness cluster at 6 months after discharge because of the lower incidence rate. Dry mouth formed a third unique solution. (2) Before admission, the heart failure symptom clusters contained a variety of symptoms with a complicated structure.3 months after discharge, the distribution and structure of symptom clusters had changed a lot. But the symptom clusters at 6 months discharge were similar to those at 3 months discharge. The structure tends to be stable. (3) Survival analysis indicated that the occurrence of the weary cluster before admission was a protective factor for cardiac re-hospitalization or death (relative risk,0.330; 95% confidence interval,0.136-0.798; P=0.014).Conclusion:This study explored HF symptom clusters and the pattern of change through the progression of disease. Therapeutic regimen can be improved and continuing interventions on HF symptom clusters might be taken based on the results of this study, while patients’ education for self-monitoring of symptoms might focus on differences of symptom clusters at different time points.