Exploring Symptom Clusters in People with Heart Failure

Abstract

Background: A symptom cluster (SC) is a group of two or more symptoms that occur together and are related to each other. SCs have been studied primarily in oncology patients, yet the increasing volumes of people living with heart failure (HF) often experience multiple symptoms. Purpose: The purposes of this study were to: 1) determine if distinct latent classes of HF patients could be identified; 2) identify how patient characteristics influence HF SC membership; 3) explore the impact of HF SCs on adverse outcomes; and 4) compare HF SCs between a Western (U.S.) and an Asian sample (China/Taiwan). Methods: A secondary analysis of a cross-sectional observational study designed to evaluate the development of HF symptoms (Moser et al., 2014) was conducted. The sample in this study included patients recruited from inpatient and outpatient settings between years 2008 and 2011, from the U.S. (N=4011), and a matched sample from the U.S. and China/Taiwan (N=240 in each). Items from The Minnesota Living with Heart Failure Questionnaire (MLHFQ) were analyzed: five physical symptoms (edema, shortness of breath, fatigue-increased need to rest, fatigue-low energy, and sleep difficulties) and three psychological symptoms items (worrying, feeling depressed, and cognitive problems). Likert scaled responses assessed how these symptoms affected their lives. Using Mplus, latent class cluster Analysis (LCCA) was performed to examine the structure of symptoms. Results: Four distinct symptom classes were identified in the U.S. sample: all mild symptoms, moderate physical symptoms, moderate psychological symptoms, and all severe symptoms. Younger HF patients experienced greater distress from psychological symptoms, regardless of the distress of physical symptoms. Low education level was associated with higher distress from the physical symptoms. Psychological symptoms predicted ER visits and hospital admissions. Compared with the U.S. sample, HF patients from China/Taiwan reported a lower level of symptom distress, especially psychological symptoms. Conclusions: SCs should be useful for recognition of HF symptoms as a group rather than as isolated experiences. These insights may lead to the development of research strategies that target groups of symptoms. For example, an emotional support program could be proposed for younger HF patients who have a risk of psychological symptoms.