title: Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure.
abstract: BACKGROUND
  Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions.
  
  
  OBJECTIVE
  To examine the relationship between patterns of HF symptom variability, and HF event-free survival.
  
  
  METHODS
  Patients with HF (N=71) rated HF symptoms daily for 30 days. Symptoms were rated on a 10 point scale anchored at the extreme ends by "worst symptom could be" and "best symptom could be". Patients were followed for an average of 1 year to track HF and cardiac rehospitalizations and all-cause mortality.
  
  
  RESULTS
  Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality.
  
  
  CONCLUSIONS
  Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms.
authors.affiliation: University of Kentucky, Lexington, KY 40536-0232, United States. dmoser@uky.edu
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Susan K
authors.initials: SK
authors.lastname: Frazier
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Biddle
authors.forename: Misook L
authors.initials: ML
authors.lastname: Chung
authors.forename: Kyoung Suk
authors.initials: KS
authors.lastname: Lee
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010359:Patient Readmission; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate