Abstract
Symptoms of a heart failure (HF) exacerbation are numerous, distressing, and a major reason for hospitalization among patients with HF. As HF symptoms rarely occur in isolation, studying symptoms as clusters might be more effective than single symptoms in relationship to patient outcomes. Recent research has focused on the relationship between HF symptom clusters and mortality, hospitalization, functional status and quality of life. No studies to date have focused on the relationship of symptom clusters to delay in seeking treatment.
Purpose: The purpose of this study was to determine the effect of physical symptom clusters on delay in seeking treatment.
Methods: A secondary analysis of data from two exploratory studies of 406 persons with HF was completed. Demographics (age, gender, education, marital status, living situation), physical HF symptoms (Heart Failure Somatic Awareness Scale, 0-36, higher more bother) and delay (measured in hours) were collected. Agglomerative hierarchical clustering was used to determine symptom clusters. Chi square and ANOVA were computed to determine demographic differences in cluster membership and those were entered into a hierarchical regression.
Results: The sample was primarily male (55%), Caucasian (94%) and older in age (74 years+12.1 years). Mean delay was 5.7+13.9 days. Three clusters emerged (1. Discordant, 2. Edema, 3. Dyspnea) (Figure 1). Younger adults (M 70.9 vs 75.9 vs 75.2 years, p = .003, respectively) were more likely to be in cluster 1 (discordant symptoms) and delay longer than those in clusters 2 or 3 (M 8.5 vs 4.9 vs 4.5 days, p = .044, respectively). In step 1, 16% of variation in delay was explained by gender and age (β = -.134, p <.01). Three clusters (step 2) did not predict days of delay (cluster 1: β = .011, cluster 2: β = .036; cluster 3: β = .001).
Conclusions: Younger-old adults had discordant symptoms resulting in longer delay in seeking treatment. Assessment of symptom clusters and education about when to seek treatment is warranted.