Abstract
Heart failure patients experience multiple concurrent symptoms called symptom clusters. Understanding the role and characteristics of symptom clusters in heart failure (HF) patients is limited. Illness uncertainty may lead to difficulty interpreting symptoms and timely treatment. Before person-centered interventions can be developed, more information about variations in HF symptom clusters and factors associated with them are needed.
The purpose of this study was to describe HF symptom clusters and determine if illness uncertainty levels differed by symptom cluster.
A total of 129 HF patients (mean age 76.4 (12.4) years, education 10.6 (3.2) years and time with HF 3.6 (5.9) years, 54% male, 93% Caucasian, 46% widowed/divorced, NYHA class III) completed the Heart Failure Somatic Perception Scale (HFSPS, 0-90, higher score indicates more symptoms) and Mishel's Uncertainty in Illness Scale (MUIS, 23-115, higher score indicates more uncertainty) during hospitalization. Symptom clusters were determined by hierarchical agglomerative clustering techniques in SPSS 25. After controlling for differences in age, gender and length of time with HF, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group.
Three clusters were found: 1. Shortness of breath cluster (SOB), n = 43 (fatigue, hard to breathe, SOB when dressing, orthopnea, DOE, PND, rest during day, wake urinate at night), 2. Edema cluster, n = 47 (swollen feet, tight shoes, tight clothes, weight gain), 3. Cardiac symptom cluster, n = 39 (palpitations, chest pain, upset stomach, decreased appetite, cough). After adjusting for age, gender and length of time with HF, there was a significant difference in uncertainty levels by symptom cluster group (p = .000). Post hoc analysis demonstrated that cardiac cluster members reported less illness uncertainty than edema cluster members (69.7 vs 75, respectively, p = .033).
Results suggest that significant differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.