Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure.
Quin E Denfeld, Julie T Bidwell, Jill M Gelow and 4 others
PMID 31753526WHAT IT FOUND
In 274 adults with heart failure, those whose physical and emotional symptom severity did not match were more likely to die for any cause or have a cardiovascular hospital or emergency room admission within 180 days than those with mild matched symptoms.
Key findings
01Physical and emotional symptom severity were usually matched: severe physical symptoms were more likely with severe emotional symptoms, and mild physical symptoms with mild emotional symptoms.
02The incongruent symptom group, made of mild physical with severe emotional symptoms or severe physical with mild emotional symptoms, was 98% more likely to have a 180-day event than the congruent-mild group after adjustment (p = 0.014).
03The congruent-severe symptom group did not have a significantly higher 180-day event likelihood than the congruent-mild group after adjustment (p = 0.261).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Participants came from one outpatient advanced heart failure clinic in the Pacific Northwest and were mostly young, male, and non-Hispanic Caucasian, so the results may not apply to all heart failure patients. Symptoms were measured at one baseline time point, so the study cannot show how physical and emotional symptoms changed over time or which came first. Only dyspnea, sleep-wake disturbance, depression, and anxiety were measured; other common symptoms such as pain and gastrointestinal symptoms were not included. The incongruent group was small and included both mild physical/severe affective and severe physical/mild affective patients, so the study cannot identify outcomes or determinants for those smaller groups separately. This is an observational prognostic analysis, not a treatment trial; it cannot show that changing a symptom cluster or a medication would improve survival. The congruent-severe group did not have significantly worse outcomes at 180 days, which may reflect short follow-up or differences in treatment.
Declared interests
No conflicts of interest were declared. The article is tagged as supported by NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the higher event risk as proof that treating one symptom cluster will improve survival. The symptom mismatch was measured once, the incongruent group was small and combined, and the study cannot separate medication effects or other factors.