| Objective: To investigate the prevalence?severity and distress of symptoms in patients with chronic heart failure at the time of admission,1 month,3 months and 6months.Explore the types and composition of the symptom clusters of patients at different time points.Analyze the relationships between symptom clusters and quality of life of patients at different time points.The results may help healthcare professionals to draft manage multiple symptoms to provide a theoretical basis.Methods: Using the convenience sampling method,201 patients with chronic heart failure who were hospitalized in the cardiovascular department of a tertiary public hospitals in Guizhou Province from October 2018 to August 2019 were selected as subjects.Used the Chinese version of Memorial Symptom Assessment Scale Heart Failure and the Minnesota Living with Heart Failure Questionnaire to longitudinally investigate multiple symptoms and quality of life at different times during admission,1 month,3 months and 6 months.Descriptive statistic method was used to analyze the general information,symptom experience and quality of life.Exploratory factor analysis was used to determine the symptom clusters at different time points.Spearman correlation analysis method was used to analyze the relationship between symptom clusters and quality of life at different time points.Results:1.The completion of this investigation: 201 patients completed the first survey,during 6 months after discharge,41 patients were lost,including 16 missing patients,7 deaths and 18 rehospitalizations.Finally,160 patients completed the survey.2.The median number of symptoms experienced by patients at admission,1 month,3 months and 6 months after discharge was 2-11;the prevalence of each symptom was 0.52% to 78.11%,the severity score was 1 to(3.01 ± 0.72),and the distress score was 1 to(3.21 ± 0.54)at each time point.(1)Admission: The median number of symptoms experienced by the patients was 11.The 3 symptoms with the highest prevalence were shortness of breath(78.11%),fatigue(73.13%)and sleep difficulty(67.16%);the 3 symptoms with the highest severity were shortness of breath(3.01 ± 0.72),fatigue(2.97 ± 0.60)and sleep difficulty(2.61 ± 0.67);the 3 symptoms with the highest distress were shortness of breath(3.21 ± 0.54),fatigue(2.97 ± 0.65)and sleep difficulty(2.94 ± 0.68).(2)1 month after discharge: The median number of symptoms experienced by the patients was 2.The 3 symptoms with the highest prevalence were fatigue(28.64%),shortness of breath(23.95%)and sweating(23.43%);the 3 symptoms with the highest severity were anxiety(2.20 ± 0.80),sadness(2.12 ± 0.75)and sweating(2.04± 0.60);the 3 symptoms with the highest distress were skin itching(2.33 ± 0.70),dry mouth(2.15 ± 0.52)and bloating(2.11 ± 0.78).(3)3 months after discharge: The median number of symptoms experienced by the patients was 3.The 3 symptoms with the highest prevalence were fatigue(40%),shortness of breath(34.85%)and dry mouth(32%);the 3 symptoms with the highest severity were fatigue(2.23 ± 0.70),shortness of breath(2.20 ± 0.67)and sleep difficulty(2.00 ± 0.59);the 3 symptoms with the highest distress were shortness of breath(2.23 ± 0.64),fatigue(2.11 ± 0.75)and sorrow(2.08 ± 0.55).(4)6 months after discharge: The median number of symptoms experienced by the patients was 3.The 3 symptoms with the highest prevalence were fatigue(42.5%),shortness of breath(38.75%)and sleep difficulty(38.12%);the 3 symptoms with the highest severity were fatigue(2.31 ± 0.60),shortness of breath(2.24 ± 0.59)and sleep difficulty(2.02 ± 0.69);the 3 symptoms with the highest distress were fatigue(2.25 ± 0.72),shortness of breath(2.19 ± 0.67)and sleep difficulty(2.00 ± 0.60).3.The symptom clusters in patients with chronic heart failure at different time points:(1)Admission: there were 6 symptom clusters,including the fatigue(fatigue,sleep difficulty,a lack of appetite),dyspneic(waking up breathless at night,difficulty breathing when lying flat,shortness of breath),discomfort(sleepiness,dry mouth,sweating),congestive(cough,swollen,bloating,nausea,abnormal urination),ischemic(dizziness,palpitations,chest pain)and emotional(nervousness,anxiety,sadness)symptom clusters.The 6 symptom clusters together explained 57.51% of the variance.(2)1 month after discharge: there were 3 symptom clusters,including physical symptom cluster(palpitation,shortness of breath,fatigue),sickness symptom cluster(dry mouth,sweating,cough)and emotional symptom cluster(anxiety,sadness).The3 symptom clusters together explained 66.09% of the variance.(3)3 months after discharge: there were 2 symptom clusters,including tired symptom cluster(sleep difficulty,fatigue,shortness of breath),illness symptom cluster(sweating,palpitation,cough,dry mouth).The 2 symptom clusters together explained 50.87% of the variance.(4)6 months after discharge: there were 2 symptom clusters,including tired symptom cluster(sleep difficulty,shortness of breath,fatigue),illness symptom cluster(sweating,palpitation,dry mouth).The 2 symptom clusters together explained 57.07% of the variance.4.The relationship between symptom clusters and quality of life at different time points in patients with chronic heart failure: the scores of quality of life at admission,1 month,3 months,6 months after discharge were 46.38 ± 9.39,29.75 ± 5.58,30.00± 4.96,and 30.47 ± 5.56.Analysis of variance showed that the difference total in quality of life of patients at four time points was statistically significant(P < 0.01).5.The relationship between symptom clusters and quality of life at each time point:(1)Admission: the fatigue symptom cluster bad significantly positive correlated with the quality of life(r = 0.542,P < 0.01);the dyspneic symptom cluster bad significantly positive correlated with the quality of life(r = 0.403,P < 0.01);the discomfort symptom cluster bad significantly positive correlated with the quality of life(r = 0.293,P < 0.01);the congestive symptom cluster bad significantly positive correlated with the quality of life(r = 0.479,P < 0.01);the ischemic symptom cluster bad significantly positive correlated with the quality of life(r = 0.143,P < 0.05);the emotional symptom cluster bad significantly positive correlated with the quality of life(r = 0.357,P < 0.01).(2)1 month after discharge: the physical symptom cluster bad significantly positive correlated with the physical dimension of quality of life(r = 0.235,P <0.01);the emotional symptom cluster bad significantly positive correlated with the psychological dimension of the quality of life(r = 0.259,P < 0.01).(3)3 months and 6 months after discharge: the tired symptom cluster bad significantly positive correlated with the physical dimension of quality of life(r =0.435 ~ 0.623,P < 0.01);the illness symptom cluster bad significantly positive correlated the other dimension of quality of life(r = 0.190 ~ 0.486,P < 0.01).Conclusion:1.The prevalence?severity and distress of symptoms in patients with chronic heart failure at the time of admission,1 month,3 months and 6 months after discharge are difference.The prevalence of shortness of breath and fatigue is the highest which bring considerable burden to patients with chronic heart failure.2.The various symptoms experienced by patients with chronic heart failure at the time of admission,1 month,3 months and 6 months after discharge can be gathered into clusters through exploratory factor analysis.The types and composition of the patient's symptom clusters are different at admission and at different time points after discharge.3.The scores of quality of life and its dimensions of patients with chronic heart failure are different at the time of admission,1 month,3 months and 6 months after discharge.Symptom clusters are inversely related to quality of life,which indicates that symptom clusters impair quality of life in patients with chronic heart failure and the influence degree is varying. |
PDF Full Text Request