title: Heart failure symptom clusters and functional status - a cross-sectional study.
abstract: OBJECTIVE
  To identify symptom clusters in individuals with heart failure and evaluate the relationship of the identified clusters to functional status.
  
  
  BACKGROUND
  Heart Failure is a global health problem affecting approximately 1-2% of the adult population in developed countries worldwide. Individuals with heart failure may experience as many as nine symptoms and may limit activities that worsen their symptoms or adjust the way they engage in activities.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  A convenience sample of individuals (n = 117) with a confirmed diagnosis of heart failure was recruited from an academic medical centre during 2011-2012. Prevalent heart failure symptoms and functional status outcomes (functional limitations and mobility) were evaluated. Factor analysis using the principal components method was used to extract symptom clusters. Regression analysis using a backwards stepwise model-building approach was used to examine the effects of the symptom clusters, age and co-morbidity on functional limitations and mobility.
  
  
  RESULTS
  Three symptom clusters, sickness behaviour, discomforts of illness and gastrointestinal distress were extracted. When sickness behaviours and discomforts of illness were both present, functional limitations were more sensitive to sickness behaviours. Sickness behaviour and co-morbidity were related to limited mobility.
  
  
  CONCLUSIONS
  Individuals with heart failure may be helped to improve their functional status by managing sickness behaviour and discomforts of illness symptoms. Identification of symptom clusters may lead to the development of interventions focusing on a cluster of heart failure symptoms.
authors.affiliation: CJW Medical Center, Richmond, Virginia, USA.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Herr
authors.affiliation: School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Salyer
authors.affiliation: Virginia Commonwealth University Health System, Richmond, Virginia, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Flattery
authors.affiliation: School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Goodloe
authors.affiliation: College of Nursing, University of Florida, Gainesville, Florida, USA.
authors.forename: Debra E
authors.initials: DE
authors.lastname: Lyon
authors.affiliation: Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio, USA.
authors.forename: Christine Schubert
authors.initials: CS
authors.lastname: Kabban
authors.affiliation: School of Allied Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA.
authors.forename: Dolores G
authors.initials: DG
authors.lastname: Clement
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: functional status; heart failure; nursing; symptom; symptom cluster