title: Heart failure symptom relationships: a systematic review.
abstract: BACKGROUND
  Heart failure is a prevalent chronic health condition in the United States. Individuals who have heart failure experience as many as 2 to 9 symptoms. The examination of relationships among heart failure symptoms may benefit patients and clinicians who are charged with managing heart failure symptoms.
  
  
  OBJECTIVE
  The purpose of this systematic review was to summarize what is known about relationships among heart failure symptoms, a precursor to the identification of heart failure symptom clusters, as well as to examine studies specifically addressing symptom clusters described in this population.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in the conduct of this systematic review. PubMed, PsychINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Database were searched using the search term heart failure in combination with a pair of symptoms.
  
  
  RESULTS
  Of a total of 1316 studies identified from database searches, 34 were included in this systematic review. More than 1 investigator found a moderate level of correlation between depression and fatigue, depression and anxiety, depression and sleep, depression and pain, anxiety and fatigue, and dyspnea and fatigue.
  
  
  CONCLUSIONS
  The findings of this systematic review provide support for the presence of heart failure symptom clusters. Depression was related to several of the symptoms, providing an indication to clinicians that individuals with heart failure who experience depression may have other concurrent symptoms. Some symptom relationships such as the relationships between fatigue and anxiety or sleep or pain were dependent on the symptom characteristics studied. Symptom prevalence in the sample and restricted sampling may influence the robustness of the symptom relationships. These findings suggest that studies defining the phenotype of individual heart failure symptoms may be a beneficial step in the study of heart failure symptom clusters.
authors.affiliation: Janet K. Herr, MS, RN PhD Candidate, Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond. Jeanne Salyer, PhD, RN Associate Professor, Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond. Debra E. Lyon, PhD, RN, FNP-BC, FAAN Professor, Department of Community Health Nursing, Virginia Commonwealth University, Richmond. Lauren Goodloe, PhD, RN Clinical Associate Professor, Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond. Christine Schubert, PhD, MBA Assistant Professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright Patterson Air Force Base, Ohio. Dolores G. Clement, DrPH, FACHE Professor, Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Herr
authors.forename: Jeanne
authors.initials: J
authors.lastname: Salyer
authors.forename: Debra E
authors.initials: DE
authors.lastname: Lyon
authors.forename: Lauren
authors.initials: L
authors.lastname: Goodloe
authors.forename: Christine
authors.initials: C
authors.lastname: Schubert
authors.forename: Dolores G
authors.initials: DG
authors.lastname: Clement
mesh_terms: D016000:Cluster Analysis; D003072:Cognition Disorders / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005221:Fatigue; D006333:Heart Failure / Q000453:epidemiology* / Q000523:psychology; D006801:Humans