| Background: Symptom perception is key to successful self-care management.Effective selfcare of heart failure and optimal health-related quality of life are largely dependent on patient competence in recognition,interpretation,and reporting of symptoms.However,many studies indicated that heart failure patients lacked effective perception of their symptoms.In China,no previous research was found which assessed symptom perception of hospitalized patients with acute heart failure.Purpose: The purposes of this study were to: 1)describe how do Chinese patients with acute heart failure perceive their symptoms,and 2)explore the relationship between personal,psychological,and physiological factors and symptom perception.Methods: Based on the revised and updated version of the Situation-Specific Theory of Heart Failure Self-Care,a descriptive,correlational cross-sectional design was used in this study.A convenience sample of hospitalized patients diagnosed with acute heart failure was enrolled from five units of two departments of cardiology of two tertiary hospitals in Wuhan,China,from May 1,2019 to October 31,2019.Data was collected via the structured questionnaire survey and retrieved from the medical records.Scales included the Changsha Version of Montreal Cognitive Assessment(Mo CA)Test,the Chinese version of Patient Health Questionnaire-8(PHQ-8),the Chinese version of Patient-Reported Outcomes Measurement Information System(PROMIS)Short Form v1.0-Anxiety 4a,and the Heart Failure Somatic Perception Scale(HFSPS).Bivariate analysis and Hierarchical Multiple Linear Regression method were used to identify independent factors influencing symptom perception in Chinese patients with heart failure.Results: Two hundred and eight patients completed the research protocol and finished the questionnaire survey.The overall mean HFSPS score was 43.16±10.949(range,7 to 69).Dyspnea(mean,3.217±2.360)and chest discomfort(mean,2.952±3.036)were the two symptoms most reported by the participants.Weight-gain during the past week was not reported by most of the patients(82.7%).Scores of the early and subtle subscale were low(mean,2.107±2.053).Over half of the patients(84.6%)reported that they did not feel their clothes felt tight around their waist before the admission.The mean duration of heart failure was 40 months and the mean duration of symptoms was over 2 weeks.The mean left ventricular ejection fraction(LVEF)was 38.23% and the mean N-terminal pro-B-type natriuretic peptide(NT-pro BNP)of the participants was 8962.14 pg/ml.Over half of the patients(76.9%)were at a high level of comorbidity with a Charlson Comorbidity Index(CCI)score over 5.Most of the patients(51.0%)were at a New York Heart Association(NYHA)Functional Class ?.Nearly all the patients(98.6%)were cognitively impaired.Of the 208 patients,22(10.6%)had moderate or greater depressive symptoms and 17(8.2%)patients were at a high score of anxiety.The results of bivariate analysis showed significant differences of symptom perception in LVEF(p=0.001),NT-pro BNP(p=0.001),anxiety(p=0.010),educational background(p=0.023),perceived economic status to meet needs(p=0.014),depression(p=0.001),and NYHA Functional Class(p=0.000).The results of the Hierarchical Multiple Linear Regression indicated the LVEF value,educational background,the existence of mild depression,and the NYHA Functional Class were the independent predictors of symptom perception in Chinese heart failure patients.Specifically,a higher LVEF value and higher level of educational background were independent predictors associated with poorer symptom perception,whereas the NYHA Functional Class were independent facilitators of symptom perception in Chinese patients with HF;patients without depression had a poorer perception of symptoms than those with depression..Conclusions: This study provides a preliminary understanding of symptom perception and its independent influencing factors in Chinese patients with heart failure.The ability of Chinese patients with heart failure to perceive their symptoms was affected by personal,psychological,and physiological factors.This study suggests patients with poor symptom perception might be able to be identified and be provided with more individualized self-care support for Chinese patients with heart failure by using these independent influencing factors in the future clinical practice.At the same time,further research on a more diverse sample of symptom perception in China and other countries is recommended. |
PDF Full Text Request