Symptoms in Heart Failure

Heart failure is a complex, disabling, and modifiable condition. On a global scale, an estimated 26 million people worldwide have heart failure.¹ Approximately 5.9 million Americans suffer from HF. About half of people who develop heart failure die within 5 years of diagnosis, and just under 10% of deaths each year include HF as a factor. HF costs an estimated $30.7 billion each year.² This total includes the cost of health care services, medications to treat heart failure, and missed days of work. HF is a complex syndrome and its manifestations are heterogenous. Heart failure (HF) carries a high degree of morbidity and mortality. The complicated symptom profile of HF characterized by concurrent symptoms emerging from multiple causes (ie. Complicated/ multi-system HF related dysfunctions, co-morbidities, and burden or complications of medical treatment) makes symptom management in HF challenging. Examining symptom clusters in HF can provide clinicians with better understanding about patients’ symptom experiences which may guide clinical management and transitions of care planning. Building upon these facts, the purpose of this cross-sectional symptom survey study is to attempt to understand symptoms experienced by patient hospitalized with HF. The multifactorial and complex nature of HF syndrome and the chronicity of this disease served as framework of this inquiry.

Methods

A Cross-sectional, retrospective study design was utilized for this study. Electronic admission records of patients hospitalized with a primary diagnosis of heart failure or heart failure exacerbation were reviewed. Data extraction focused on patient reported presenting symptoms and was limited to other relevant descriptive data at the date and time of admission. Palliative Care Outcome scale was used to assess severity of symptom burden.

Descriptive statistics were computed for the entire sample utilizing SPSS v. 23. This statistical software package was also used for principal components factor analysis.

Setting and Sample

Patients who were hospitalized with primary diagnosis of HF or HF exacerbation on an Advanced HF inpatient service at an academic, quaternary care level hospital in an urban setting in Pennsylvania were eligible for inclusion in the study. A convenience sample of patients from 2017 were utilized.

Results

Study participants were predominantly male sample with a mean age of 57.6 years.
The American College of Cardiology/American Heart Association Task Force (ACC/AHA) HF Staging for sample of patients was primarily Stage C. The New York Heart Association (NYHA) Functional Class upon admission were most commonly documented as III and IV. Symptoms that are typically associated with fluid overload such as dyspnea and edema were the most commonly reported symptom. Symptoms that can be related to decreases in cardiac output and those that impacted perfusion such as weakness/fatigue, and poor mobility were also common.

Limitations

Our study results are limited by the small convenience sample of established patients with advanced HF only. Furthermore, the Palliative Outcome Scale Survey tool used is not specifically designed for the cardiovascular patient population, although it has been used in the past. Due to the data extraction methods used in the study, sampling bias is a concern.

Conclusion

Symptoms related to fluid overload and decrease perfusion are the most common symptoms in patients admitted with HF in this small study. A larger, and preferable, prospective study is required to further investigate symptom clusters in HF patients and to better understand the impact symptom cluster management may have in the development patient management plans.