Barbara Riegel1, Victoria Vaughan Dickson2, Christopher S Lee3, Marguerite Daus4, Julia Hill5, Elliane Irani6, Solim Lee4, Joyce W Wald7, Stephen T Moelter8, Lisa Rathman9, Megan Streur10, Foster Osei Baah4, Linda Ruppert11, Daniel R Schwartz11, Alfred Bove11. 1. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: briegel@nursing.upenn.edu. 2. College of Nursing, New York University, New York, NY, USA. 3. School of Nursing, Oregon Health & Sciences University, Portland, OR, USA. 4. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. 5. Community Healthcare Network, New York, NY, USA. 6. School of Nursing, Case Western Reserve University, Cleveland, OH, USA. 7. Heart Failure - Transplant Program, University of Pennsylvania, Philadelphia, PA, USA. 8. Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA. 9. The Heart Group of Lancaster General Health/PENN Medicine, Philadelphia, PA, USA. 10. School of Nursing, University of Washington, Seattle, Washington, USA. 11. Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Abstract
BACKGROUND: Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. METHODS: We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. RESULTS: In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. CONCLUSION: Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.
BACKGROUND: Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. METHODS: We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. RESULTS: In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. CONCLUSION: Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.
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