Background:
Although symptoms in patients (pts) with heart failure (HF) are often viewed in isolation, pts usually have multiple, concurrent symptoms. Identification of symptom clusters could improve pts’ recognition of worsening HF, and enhance pt care. Given gender differences in outcomes in HF, examination of potential differences in clusters and their impact on outcomes is reasonable.
Purpose:
To identify HF symptom clusters in women and men and examine the impact of clusters on total number of all-cause hospitalizations per pt during 12 month follow-up.
Methods:
Data from 513 pts with HF (61 ± 12 yrs, 31.7% female, 53.6% NYHA III/IV) were used. Seven symptoms (i.e., edema, dyspnea, fatigue, trouble sleeping, worry, depression, and memory problems) were analyzed for clustering using an agglomerative hierarchical clustering approach and Ward’s method. Validity of cluster solution was assessed with split-sample replication. Symptoms were clustered, and pts were grouped based on symptom burden in clusters.
Results:
Two symptom clusters were identified in both men and women:
physical symptom cluster - dyspnea, fatigue, trouble sleeping; and
emotional/cognitive symptom cluster - worry, memory problems, depression.
Pts were grouped into 4 based on their symptom burden in each of the 2 clusters:
low burden related to both clusters;
burden from physical cluster > than that from emotional cluster;
burden from the emotional cluster > than that from physical cluster; and
high and equal burden from both clusters.
ANOVA revealed a difference in number of hospitalizations in both men and women based on the groups (p=.002); there were no gender differences. Pts in group 3 (emotional symptoms > than physical) were most frequently hospitalized (1.8 ± 2.8 hospitalizations/pt in group 3 compared to 1.7 ± 2.5/pt in group 4 vs .88 ± 1.6/pt in group 2 vs .66 ± 1.3/pt in group 1; post hoc Tukey indicates p <.05 for all comparisons except group 3 with 4).
Conclusion:
HF symptoms cluster in two identifiable groups: a physical and an emotional/cognitive cluster. Pts with the most burden from the emotional cluster have the worst outcomes, suggesting that increased attention needs to be paid by clinicians to emotional symptoms and the fact that they occur in clusters.
Background and Design of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) Study
