Identification, Associated Factors, and Prognosis of Symptom Clusters in Taiwanese Patients With Heart Failure

10.1097/jnr.0000000000000199

Tsuey-Yuan Huang；Debra K. Moser；Shiow-Li Hwang

heart failure ； symptom cluster ； hospitalization ； mortality

The Journal of Nursing Research

26卷1期（2018 / 02 / 01）

60 - 67

英文

Background: Patients with heart failure (HF) have multiple distressing symptoms that are associated with poor outcomes. These symptoms do not occur in isolation from each other but likely occur as discrete clusters that may prove helpful to clinicians trying to counsel patients about symptom monitoring and management. Defining common symptom clusters and determining the associations between symptom clusters and outcomes may improve patient management. Purpose: The aim of this study was to define symptom clusters and their association with event-free survival in terms of cardiac hospitalization and all-cause mortality in patients with HF. Methods: Patients were recruited from outpatient HF clinics. Physical symptoms (dyspnea, fatigue, edema, sleeplessness, anorexia, and poor memory) were measured using the modified Pulmonary Function Status and Dyspnea Questionnaire and the Minnesota Living with Heart Failure Questionnaire. A two-stage cluster analysis was conducted to identify subgroups of patients based on the self-perceived severity of the six symptoms. The Kaplan-Meier survival curve and log-rank test were used to assess whether symptom clusters were associated with event-free survival through a 12-month follow-up. Results: Two hundred fifty-eight patients (mean age = 61.2 ± 12.3 years, 75% male, 41% New York Heart Association class III/IV) participated. Three symptom clusters were identified based on the severity of symptoms. These clusters were called the nonsevere symptom cluster (all symptoms were rated with low severity), the typical severity symptom cluster (high level of severity for dyspnea and fatigue, low level of severity for edema, and moderate level of severity for all other symptoms), and the atypical severity symptom cluster (low level of severity for dyspnea and fatigue, high level of severity for edema, and moderate level of severity for all other symptoms). Symptom clusters were associated with event-free survival (p ＜ .001). A post hoc comparison showed that the prognosis was better in the nonsevere symptom cluster than both the typical symptom (p ＜ .001) and nontypical symptom (p ＜ .001) clusters and that the prognoses for the latter two clusters did not differ significantly. Conclusions/Implications for Practice: Symptom clusters play an important role in the prognoses of patients with HF. Both patients and healthcare providers may use the information that is provided by this study to improve the surveillance and management of related symptoms.

1. Huang, T. Y.,Moser, D. K.,Hsieh, Y. S.,Gau, B. S.,Chiang, F. T.,Hwang, S. L.(2013).Moderating effect of psychosocial factors for dyspnea in Taiwanese and American heart failure patients.The Journal of Nursing Research,21(1),49-58.
   連結：
2. Aktas, A.,Walsh, D.,Rybicki, L.(2010).Symptom clusters: Myth or reality?.Palliative Medicine,24(4),373-385.
3. Alhusseiny, A. H.,Al-Nimer, M. S. M.,Latif, I. I.,Ibrahim, A. K.(2012).Heart failure: Discrepancy between NYHA functional classification, serum NT-pro brain natriuretic peptide and ejection fraction.European Journal of General Medicine,10(1),26-31.
4. Baggott, C.,Cooper, B. A.,Marina, N.,Matthay, K. K.,Miaskowski, C.(2012).Symptom cluster analyses based on symptom occurrence and severity ratings among pediatric oncology patients during myelosuppressive chemotherapy.Cancer Nursing,35(1),19-28.
5. Bruwer, B.,Emsley, R.,Kidd, M.,Lochner, C.,Seedat, S.(2008).Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth.Comprehensive Psychiatry,49(2),195-201.
6. Derogatis, S. (2006). Pearson assessmentVBrief Symptom Inventory (BSI). Retrieved from http://www.pearsonclinical.com/psychology/products/100000450/brief-symptom-inventorybsi.html?origsearchtext=100000450
7. Hair, J. F.,Black, B.,Babin, B.,Anderson, R. E.,Tatham, R. L.(2006).Multivariable data analysis.Upper Saddle River, NJ:Prentice-Hall.
8. Ho, C. C.,Clochesy, J. M.,Madigan, E.,Liu, C. C.(2007).Psychometric evaluation of the Chinese version of the Minnesota Living with Heart Failure Questionnaire.Nursing Research,56(6),441-448.
9. Huang, T. Y.,Moser, D. K.,Hsieh, Y. S.,Lareau, S. C.,Durkin, A. C.,Hwang, S. L.(2008).Validation of Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire with heart failure patients in Taiwan.American Journal of Critical Care,17(5),436-442.
10. Hwang, S. Y.,Ahn, Y. G.,Jeong, M. H.(2012).Atypical symptom cluster predicts a higher mortality in patients with first-time acute myocardial infarction.Korean Circulation Journal,42(1),16-22.
11. Kirkova, J.,Aktas, A.,Walsh, D.,Davis, M. P.(2011).Cancer symptomclusters: Clinical and research methodology.Journal of Palliative Medicine,14(10),1149-1166.
12. Kirkova, J.,Walsh, D.(2007).Cancer symptom clusters-A dynamic construct.Supportive Care in Cancer,15(9),1011-1013.
13. Lareau, S. C.,Carrieri-Kohlman, V.,Janson-Bjerklie, S.,Roos, P. J.(1994).Development and testing of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ).Heart & Lung,23(3),242-250.
14. Lareau, S. C.,Meek, P. M.,Roos, P. J.(1998).Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M).Heart & Lung,27(3),159-168.
15. Lenz, E. R.,Pugh, L. C.,Milligan, R. A.,Gift, A.,Suppe, F.(1997).The middle-range theory of unpleasant symptoms: An update.Advances in Nursing Science,19(3),14-27.
16. Lenz, E. R.,Suppe, F.,Gift, A. G.,Pugh, L. C.,Milligan, R. A.(1995).Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms.Advances in Nursing Science,17(3),1-13.
17. Lin, W. C.,Huang, T. Y.,Liu, C. Y.,Yeh, M. L.,Yu, C. H.,Hwang, S. L.(2016).Validation of the Clinical COPD Questionnaire in Taiwan, COPD.Journal of Chronic Obstructive Pulmonary Disease,13(3),360-366.
18. Moser, D. K.,Lee, K. S.,Wu, J. R.,Mudd-Martin, G.,Jaarsma, T.,Huang, T. Y.,Riegel, B.(2014).Identification of symptom clusters among patients with heart failure: An international observational study.International Journal of Nursing Studies,51(10),1366-1372.
19. Moser, D. K.,Riegel, B.,McKinley, S.,Doering, L. V.,Meischke, H.,Heo, S.,Dracup, K.(2009).The Control Attitudes Scale-Revised: Psychometric evaluation in three groups of patients with cardiac illness.Nursing Research,58(1),42-51.
20. Mozaffarian, D.,Benjamin, E. J.,Go, A. S.,Arnett, D. K.,Blaha, M. J.,Cushman, M.,American Heart Association Statistics Committee and Stroke Statistics Subcommittee(2015).Heart disease and stroke statisticsV2015 update: A report from the American Heart Association.Circulation,131(4),e29-e322.
21. Namisango, E.,Harding, R.,Katabira, E. T.,Siegert, R. J.,Powell, R. A.,Atuhaire, L.,Taylor, S.(2015).A novel symptom cluster analysis among ambulatory HIV/AIDS patients in Uganda.AIDS Care,27(8),954-963.
22. Riegel, B.,Dickson, V. V.,Cameron, J.,Johnson, J. C.,Bunker, S.,Page, K.,Worrall-Carter, L.(2010).Symptom recognition in elders with heart failure.Journal of Nursing Scholarship,42(1),92-100.
23. Riegel, B.,Lee, C. S.,Albert, N.,Lennie, T.,Chung, M.,Song, E. K.,Moser, D. K.(2011).From novice to expert: Confidence and activity status determine heart failure self-care performance.Nursing Research,60(2),132-138.
24. Sarstedt, M.,Mooi, E.(2014).A concise guide to market research.New York, NY:Springer.
25. Tsai, M. F.,Hwang, S. L.,Tsay, S. L.,Wang, C. L.,Tasi, F. C.,Chen, C. C.,Huang, T. Y.(2013).Predicting trends in dyspnea and fatigue in heart failure patients' outcomes.Acta Cardiologica Sinica,29(6),488-495.
26. Yu, H. C.,Yeh, M. L.,Tsai, M. F.,Hwang, S. L.,Lennie, T. A.,Moser, D. K.,Huang, T. Y.(2012).Ethnicity, functional class, depression, anxiety, and perceived control are predictors of health-related quality of life in patients with heart failure.Journal of Cardiac Failure,18(8),S84-S85.

1. Susan J. FETZER,Shyh-Jong WU,Shan-Tair WANG,Liang-Miin TSAI,Hsing-Mei CHEN,Chee-Siong LEE(2020).Effects of Predischarge Patient Education Combined With Postdischarge Follow-Ups on Self-Care, Readmission, Sleep, and Depression in Patients With Heart Failure.The Journal of Nursing Research,28(5),1-11.