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HF Symptom Clusters Predict Treatment-Seeking Delay
Quick Takes
- Symptom clusters can be used to stratify chronic illness risk in persons to potentially prevent adverse outcomes with evidence-based interventions.
- Emphasizing dyspnea- and edema-related symptom cluster interventions might reduce delays in treatment-seeking among persons living with HF.
Study Questions:
What is the effect of physical symptom clusters on delay in seeking treatment for heart failure (HF)?
Methods:
A retrospective, secondary analysis study from two combined prospective studies was conducted. The data sample consisted of 406 cases of patients hospitalized for HF. In the primary studies, the Heart Failure Somatic Awareness Scale was used to collect physical HF symptom data from all participants and demographic data were extracted from medical records. Treatment delay was defined as the number of days between patient-reported symptom onset and hospital admission date and time listed in the medical record. Cluster hierarchical agglomeration analysis was employed due to the exploratory nature of the study. Hierarchical multiple regression analysis was used to identify the impact of symptom clusters on delay in seeking treatment for HF as a function of age and gender.
Results:
Of the 406 patient HF cases, the average age was 74 ± 12.1 years. Most (93%) patients were White and men (55%). Twenty-six percent had attended college, while 42% had not completed high school. On average, the delay in treatment-seeking was 5.73 ± 13.9 days. Cluster analysis identified three symptom clusters. The first symptom cluster, discordant symptoms, consisted of palpitations, chest pain, nausea, and cough. Symptom cluster-2, edema-related symptoms, consisted of edema, tight shoes, and weight gain. The third symptom cluster consisted of dyspnea symptoms, including dyspnea, dyspnea on exertion, fatigue, orthopnea, and paroxysmal nocturnal dyspnea.
Between the three symptom clusters, age was significantly different, with lower mean age in symptom cluster-1 (p = 0.003). Delay time was significantly longer in symptom cluster-1 (discordant symptoms) compared with symptom clusters-2 and -3 (p = 0.044). However, in step-2 of the regression analysis, cluster membership did not predict treatment-seeking delay.
Conclusions:
Variability in symptoms among persons with HF is common. While the age of patients in this study differed by cluster, cluster membership did not predict treatment-seeking delay time. Symptom clusters related to edema and dyspnea were more common in symptomatic persons than cardiac symptoms such as chest pain, which can be emphasized in interventions aimed at expediting treatment-seeking.
Perspective:
Worsening symptoms in patients with HF are major reasons for hospitalization, increased morbidity, mortality, and health care costs, and reduced quality of life. This secondary analysis study on symptom clusters that might influence the timing of treatment-seeking behavior provides the foundation for future research using artificial intelligence in predicting who might benefit from targeted interventions to expedite time-to-treatment and improve outcomes.
Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Cardiovascular Care Team, Prevention
Keywords: Dyspnea, Edema, Heart Failure, Treatment Outcome
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