Sethares KA, Viveiros JD, Ayotte B. Uncertainty levels differ by physical heart failure symptom cluster.
Appl Nurs Res 2021;
60:151435. [PMID:
34247783 DOI:
10.1016/j.apnr.2021.151435]
[Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND
The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF.
AIMS
Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster.
METHODS
Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group.
RESULTS
One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033).
CONCLUSIONS
Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.
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