title: Physical and psychological symptom profiling and event-free survival in adults with moderate to advanced heart failure.
abstract: : Heart failure (HF) is a heterogeneous symptomatic disorder. The goal of this study was to identify and link common profiles of physical and psychological symptoms to 1-year event-free survival in adults with moderate to advanced HF.
  
  
  METHODS
  Multiple valid, reliable, and domain-specific measures were used to assess physical and psychological symptoms. Latent class mixture modeling was used to identify distinct symptom profiles. Associations between observed symptom profiles and 1-year event-free survival were quantified using Cox proportional hazards modeling.
  
  
  RESULTS
  The mean age of the participants (n = 202) was 57 ± 13 years, 50% were men, and 60% had class III/IV HF. Three distinct profiles, mild (41.7%), moderate (30.2%), and severe (28.1%), that captured a gradient of both physical and psychological symptom burden were identified (P < .001 for all comparisons). Controlling for the Seattle HF Score, adults with the moderate symptom profile were 82% more likely (hazard ratio, 1.82; 95% confidence interval, 1.07-3.11; P = .028) and adults with the severe symptom profile were more than twice as likely (hazard ratio, 2.06; 95% confidence interval, 1.21-3.52; P = .001) to have a clinical event within 1 year than patients with the mild symptom profile.
  
  
  CONCLUSIONS
  Profiling patterns among physical and psychological symptoms identifies HF patient subgroups with significantly worse 1-year event-free survival independent of prognostication based on objective clinical HF data.
authors: Christopher S. Lee, PhD, RN, FAHA Assistant Professor, School of Nursing, Oregon Health & Science University, Portland. Jill M. Gelow, MD, MPH Assistant Professor, School of Medicine, Oregon Health & Science University, Portland. Quin E. Denfeld, BSN, RN PhD Student, School of Nursing, Oregon Health & Science University, Portland. James O. Mudd, MD Assistant Professor, School of Medicine, Oregon Health & Science University, Portland. Donna Burgess, RN, BSN Heart Failure Nurse, Oregon Health & Science University Hospital, Portland. Jennifer K. Green, MS Research Associate, School of Nursing, Oregon Health & Science University, Portland. Shirin O. Hiatt, MPH, MS, RN Research Associate, School of Nursing, Oregon Health & Science University, Portland. Corrine Y. Jurgens, PhD, RN, FAHA Associate Dean for Research, Associate Professor, School of Nursing, Stony Brook University, New York.
authors: Christopher S
authors: CS
authors: Lee
authors: Jill M
authors: JM
authors: Gelow
authors: Quin E
authors: QE
authors: Denfeld
authors: James O
authors: JO
authors: Mudd
authors: Donna
authors: D
authors: Burgess
authors: Jennifer K
authors: JK
authors: Green
authors: Shirin O
authors: SO
authors: Hiatt
authors: Corrine Y
authors: CY
authors: Jurgens
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D018570:Risk Assessment; D012648:Self Care; D012720:Severity of Illness Index; D016019:Survival Analysis