A cluster analysis of psychological and physical symptoms in patients with heart failure

Type of funding sources: Public Institution(s). Main funding source(s): CECRI (Center of Excellence for Nursing Scholarship) Rome

The experience of psychological and physical symptoms of heart failure can be burdensome for patients. Identification of profiles of symptom burden may lead to greater understanding of the mechanism underlying this experience and improve symptom-centered care.

The aim of this analysis was to identify profiles of psychological and physical symptoms in heart failure patients and compare the sociodemographic and clinical characteristics of patients in each cluster.

This was a secondary analysis of baseline data from the MOTIVATE-HF trial, that enrolled 510 patients across Italy. Cluster analysis was used to identify profiles of patients based on the two scores of the Hospital Anxiety and Depression scale and the total score of the Heart Failure Somatic Perception Scale. Each profile was described in terms of sociodemographic characteristics (e.g., age, gender, severity of disease), self-care maintenance and management behaviors, and self-efficacy (Self-care of Heart Failure Index), generic quality of life (12-item Short Form Survey), health-related quality of life (Kansas City Cardiomyopathy Questionnaire), and cognitive status (Montreal Cognitive Assessment Scale). Comparisons between the characteristics of each profile were performed by analysis of variance (ANOVA) and chi square test.

Patients (n = 510) were 72.37 years old on average (SD = 12.28), with a slightly higher prevalence of men (58%). Sixty per cent of the sample were symptomatic: New York Heart Association (NYHA) class 2, 31.4% in NYHA class III, and 6.5% in NYHA class IV. Three profiles were identified: (1) low distress, characterized by the youngest patients (69.76, SD = 12.17), mostly in NYHA class II, and with the highest score on self-care self-efficacy and self-care maintenance behaviors; (2) average distress, characterized by the oldest patients (74.45, SD = 11.99), who were mostly retired, with the highest level of education, and poorest (physical) health-related quality of life and low self-care behaviors; (3) high distress, characterized by an average age of 73.08 (SD = 12.29), with the lowest hemoglobin level, the worst cognitive status, and the worst generic and health-related quality of life.

The profiles identified in this study and their characteristics provide new insights into the burden of psychological and physical symptoms experienced by heart failure patients. This represents the first step in promoting symptom-centered care in the future.