Physical and Psychological Symptom Profiling and Event-Free Survival in Adults With Moderate to Advanced Heart Failure

Lee, Christopher S.; Gelow, Jill M.; Denfeld, Quin E.; Mudd, James O.; Burgess, Donna; Green, Jennifer K.; Hiatt, Shirin O.; Jurgens, Corrine Y.

doi:10.1097/jcn.0b013e318285968a

Cited by 52 publications

(71 citation statements)

References 62 publications

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“…3,4,12,18–20 For example, symptoms have been inferred from quality of life measures, 19 HF-specific symptom instruments, 3,4,20 study-specific questionnaires 18 and from symptom dairies. 12 Timeframes for symptom recall among the various measures range from one to 30 days, and the number of symptoms assessed ranges from a minimum of four up to eighteen.…”

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confidence: 99%

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Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception

2017

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Background Symptoms are known to predict survival among patients with heart failure (HF) but discrepancies exist between patients’ and health providers’ perceptions of HF symptom burden. Objective The purpose of this study was to quantify the internal consistency, validity and prognostic value of patient perception of a broad range of HF symptoms using a HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v.3. Methods Factor analysis of the HFSPS was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Divergent validity was examined using the Self-Care of HF index self-care management score. One-year survival based on HFSPS scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics and lab values. Results The sample was 63% male, 85% Caucasian, 67% functionally compromised (NYHA class III-IV) with a mean age of 63, SD12.8 years. Internal consistency of the HFSPS was α =.90. Convergent (r=−0.54, p=<0.0001) and divergent (r=0.18, p>0.05) validity were supported. Controlling for Seattle HF scores, HFSPS was a significant predictor of one-year survival with those most symptomatic having worse survival (HR=1.012 (95%CI=1.001–1.024), p=0.038). Conclusions Perception of HF symptom burden as measured by the HFSPS is a significant predictor of survival contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms may be useful in evaluating therapeutic outcomes and predicting event-free survival.

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confidence: 99%

“…4,12,18–20 Moreover, the measurement of dyspnea, a hallmark symptom of HF that is well-known to vary in intensity based on activity and illness severity, was limited to a single item in half of these studies 12,18,19 and dyspnea on exertion was only measured in one study. 3 …”

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Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception

2017

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“…In one study, patients with HF with moderate symptom burden were 82% more likely than those with low symptom burden to have an adverse clinical event within a year, and patients with severe burden were more than twice as likely. 33 The current study provided action plans to respond to increased symptoms or weight including a script to call physicians and a separate diary to record response to treatment. All intervention patients who were asked to complete daily diaries received the same HF education, thus education alone did not impact clinical outcomes.…”

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confidence: 99%

Symptom Diary Use and Improved Survival for Patients With Heart Failure

Park

Dracup

Whooley

et al. 2017

Circ: Heart Failure

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Background Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of the study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. Methods and Results This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were male, and 67% completed diaries (N=393). We formed 5 groups (No Use, Low, Medium, High, Very High) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, HF-related readmission) starting at 3 months. Compared with patients with No diary use, High and Very High diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (OR, 0.66; 95% CI, 0.46–0.95; P=0.03). Depression and gender were not significant predictors of diary use in the adjusted model. Conclusion In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes.

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“…The goal of the first study was to quantify the prognostic values of physical and psychological symptoms in HF, 22 and the goal of the second study was to describe profiles of HF symptom response behaviors. 23 All participants were recruited through a single outpatient HF clinic in the Pacific Northwest that specializes in evaluating patients for advanced HF therapies.…”

Section: Methodsmentioning

confidence: 99%

“…37 In adults with HF, Cronbach’s alpha was 0.80 for the BSI hostility score and 0.86 for the BSI anxiety score. 22 …”

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confidence: 99%

Symptom-Hemodynamic Mismatch and Heart Failure Event Risk

Lee

Hiatt

Denfeld

et al. 2015

Journal of Cardiovascular Nursing

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Background Heart failure (HF) is a heterogeneous condition of both symptoms and hemodynamics. Objective The goal of this study was to identify distinct profiles among integrated data on physical and psychological symptoms and hemodynamics, and quantify differences in 180-day event-risk among observed profiles. Methods A secondary analysis of data collected during two prospective cohort studies by a single group of investigators was performed. Latent class mixture modeling was used to identify distinct symptom-hemodynamic profiles. Cox proportional hazards modeling was used to quantify difference in event-risk (HF emergency visit, hospitalization or death) among profiles. Results The mean age (n=291) was 57±13 years, 38% were female, and 61% had class III/IV HF. Three distinct symptom-hemodynamic profiles were identified. 17.9% of patients had concordant symptoms and hemodynamics (i.e. moderate physical and psychological symptoms matched the comparatively hemodynamic profile), 17.9% had severe symptoms and average hemodynamics, and 64.2% had poor hemodynamics and mild symptoms. Compared to those in the concordant profile, both profiles of symptom-hemodynamic mismatch were associated with a markedly increased event-risk (severe symptoms hazards ratio = 3.38, p=0.033; poor hemodynamics hazards ratio = 3.48, p=0.016). Conclusions A minority of adults with HF have concordant symptoms and hemodynamics. Either profile of symptom-hemodynamic mismatch in HF is associated with a greater risk of healthcare utilization for HF or death.

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Physical and Psychological Symptom Profiling and Event-Free Survival in Adults With Moderate to Advanced Heart Failure

Cited by 52 publications

References 62 publications

Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception

Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception

Symptom Diary Use and Improved Survival for Patients With Heart Failure

Symptom-Hemodynamic Mismatch and Heart Failure Event Risk

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