Debra K Moser1, Kyoung Suk Lee2, Jia-Rong Wu3, Gia Mudd-Martin4, Tiny Jaarsma5, Tsuey-Yuan Huang6, Xui-Zhen Fan7, Anna Strömberg8, Terry A Lennie4, Barbara Riegel9. 1. University of Kentucky, College of Nursing, United States. Electronic address: dmoser@uky.edu. 2. University of Wisconsin, School of Nursing, United States. 3. University of North Carolina-Chapel Hill, School of Nursing, United States. 4. University of Kentucky, College of Nursing, United States. 5. Institute of Social and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden. 6. Chang Gung University of Science and Technology, College of Nursing, Taipei, Taiwan. 7. Shandong University, School of Nursing, Shandong, China. 8. Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, Linköping University Hospital, Sweden. 9. University of Pennsylvania, School of Nursing, United States.
Abstract
BACKGROUND: Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered. OBJECTIVES: To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia. DESIGN: Cross-sectional, observational study. SETTINGS: In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States. PARTICIPANTS: A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions. METHODS: Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward's method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores. RESULTS: There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters. CONCLUSION: Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.
BACKGROUND: Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered. OBJECTIVES: To identify and compare symptom clusters in heart failurepatients from the United States, Europe and Asia. DESIGN: Cross-sectional, observational study. SETTINGS: In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States. PARTICIPANTS: A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions. METHODS: Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward's method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores. RESULTS: There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters. CONCLUSION: Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.
Authors: Kyoung Suk Lee; Eun Kyeung Song; Terry A Lennie; Susan K Frazier; Misook L Chung; Seongkum Heo; Jia-Rong Wu; Mary Kay Rayens; Barbara Riegel; Debra K Moser Journal: J Cardiovasc Nurs Date: 2010 Jul-Aug Impact factor: 2.083
Authors: Karine A S L Ferreira; Miako Kimura; Manoel J Teixeira; Tito R Mendoza; Jose Cláudio M da Nóbrega; Silvia R Graziani; Teresa Yae Takagaki Journal: J Pain Symptom Manage Date: 2008-03-24 Impact factor: 3.612
Authors: Corrine Y Jurgens; Debra K Moser; Rochelle Armola; Beverly Carlson; Kristen Sethares; Barbara Riegel Journal: Res Nurs Health Date: 2009-10 Impact factor: 2.228
Authors: Gayle G Page; Elizabeth J Corwin; Susan G Dorsey; Nancy S Redeker; Donna Jo McCloskey; Joan K Austin; Barbara J Guthrie; Shirley M Moore; Debra Barton; Miyong T Kim; Sharron L Docherty; Drenna Waldrop-Valverde; Donald E Bailey; Rachel F Schiffman; Angela Starkweather; Teresa M Ward; Suzanne Bakken; Kathleen T Hickey; Cynthia L Renn; Patricia Grady Journal: J Nurs Scholarsh Date: 2018-03-25 Impact factor: 3.176
Authors: Jonathan P Auld; James O Mudd; Jill M Gelow; Karen S Lyons; Shirin O Hiatt; Christopher S Lee Journal: Heart Lung Date: 2019-01-02 Impact factor: 2.210
Authors: Samantha Conley; Sangchoon Jeon; Stephen Breazeale; Meghan O'Connell; Christopher S Hollenbeak; Daniel Jacoby; Sarah Linsky; Henry Klar Yaggi; Nancy S Redeker Journal: Behav Sleep Med Date: 2022-04-07 Impact factor: 3.492
Authors: Nancy Fugate Woods; Lori A Cray; Ellen Sullivan Mitchell; Fred Farrin; Jerald Herting Journal: Biol Res Nurs Date: 2018-01-15 Impact factor: 2.522
Authors: Quin E Denfeld; Julie T Bidwell; Jill M Gelow; James O Mudd; Christopher V Chien; Shirin O Hiatt; Christopher S Lee Journal: Heart Lung Date: 2019-11-18 Impact factor: 2.210
Authors: Catherine J Ryan; Karen M Vuckovic; Lorna Finnegan; Chang G Park; Lani Zimmerman; Bunny Pozehl; Paula Schulz; Susan Barnason; Holli A DeVon Journal: West J Nurs Res Date: 2019-01-22 Impact factor: 1.967
Authors: Jan Cameron; Peter G Rendell; Chantal F Ski; Christina E Kure; Skye N McLennan; Nathan S Rose; David L Prior; David R Thompson Journal: Trials Date: 2015-04-29 Impact factor: 2.279