title: Symptom-Hemodynamic Mismatch and Heart Failure Event Risk.
abstract: BACKGROUND
  Heart failure (HF) is a heterogeneous condition of both symptoms and hemodynamics.
  
  
  OBJECTIVE
  The goals of this study were to identify distinct profiles among integrated data on physical and psychological symptoms and hemodynamics and quantify differences in 180-day event risk among observed profiles.
  
  
  METHODS
  A secondary analysis of data collected during 2 prospective cohort studies by a single group of investigators was performed. Latent class mixture modeling was used to identify distinct symptom-hemodynamic profiles. Cox proportional hazards modeling was used to quantify difference in event risk (HF emergency visit, hospitalization, or death) among profiles.
  
  
  RESULTS
  The mean age (n = 291) was 57 ± 13 years, 38% were female, and 61% had class III/IV HF. Three distinct symptom-hemodynamic profiles were identified: 17.9% of patients had concordant symptoms and hemodynamics (ie, moderate physical and psychological symptoms matched the comparatively good hemodynamic profile), 17.9% had severe symptoms and average hemodynamics, and 64.2% had poor hemodynamics and mild symptoms. Compared with those in the concordant profile, both profiles of symptom-hemodynamic mismatch were associated with a markedly increased event risk (severe symptoms hazards ratio, 3.38; P = .033; poor hemodynamics hazards ratio, 3.48; P = .016).
  
  
  CONCLUSIONS
  A minority of adults with HF have concordant symptoms and hemodynamics. Either profile of symptom-hemodynamic mismatch in HF is associated with a greater risk of healthcare utilization for HF or death.
authors.affiliation: Christopher S. Lee, PhD, RN, FAHA Associate Professor, School of Nursing and Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Shirin O. Hiatt, MPH, MS, RN Research Project Coordinator, School of Nursing, Oregon Health & Science University, Portland. Quin E. Denfeld, BSN, RN PhD Student and Research Associate, School of Nursing, Oregon Health & Science University, Portland. James O. Mudd, MD Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Christopher Chien, MD Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Jill M. Gelow, MD, MPH Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.forename: Shirin O
authors.initials: SO
authors.lastname: Hiatt
authors.forename: Quin E
authors.initials: QE
authors.lastname: Denfeld
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.forename: Christopher
authors.initials: C
authors.lastname: Chien
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gelow
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D006439:Hemodynamics / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D063189:Symptom Assessment