A mixed methods study of symptom perception in patients with chronic heart failure.
Barbara Riegel, Victoria Vaughan Dickson, Christopher S Lee and 12 others
PMID 29304990WHAT IT FOUND
Many heart failure patients did not sense fluid retention accurately. 8 of 18 with device data had a symptom-hemodynamic mismatch, and younger age was the only difference.
Interviews showed some missed symptoms or blamed other causes before acting.
Key findings
01Among 18 patients with OptiVol data, 8 had a mismatch between device-detected congestion and perceived fluid retention.
02Patients with mismatch were younger (53.9 ± 15.2 years) than those without mismatch (72.5 ± 7.9 years); age was the only factor that differed.
03Interviews identified two response patterns: 13 participants had difficulty detecting and interpreting symptoms, while 12 monitored, interpreted, and responded appropriately.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small, and not all participants had usable device data. Different analyses used different numbers of participants, so findings cannot be treated as a complete study of all enrolled patients. Device impedance can be affected by conditions other than heart failure and can produce false positive detections. The study observed patients and did not test whether monitoring, education, or nurse-led action plans improve symptom detection or reduce hospitalization. Qualitative themes describe patient experience and interpretation; they do not prove that a treatment works.
Declared interests
No author conflict-of-interest statement is provided in the supplied text. The article is tagged as NIH extramural and non-U.S. government research support, and the device data came from Medtronic OptiVol.
The easy way to misread this
Do not conclude that all heart failure patients misread fluid retention. The device analysis was limited to a small subgroup, and some patients did match symptoms to congestion.