title: Systematic review of symptom clusters in cardiovascular disease.
abstract: Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients' experiences with heart disease.
  
  
  
  To summarize the state of the science in symptom cluster research for patients with acute coronary syndrome, myocardial infarction, coronary artery bypass surgery, and heart failure through systematic review and to provide direction for the translation of symptom cluster research into the clinical setting.
  
  
  
  Databases were searched for articles from January 2000 through to May 2015 using MESH terms "symptoms, symptom clusters, acute coronary syndrome (ACS), myocardial infarction (MI), coronary heart disease (CHD), ischemic heart disease (IHD), heart failure (HF), coronary artery bypass surgery (CABS), cluster analyses, and latent classes." The search was limited to human studies, English language articles, and original articles investigating symptom clusters in individuals with heart disease. Fifteen studies meeting the criteria were included.
  
  
  
  For patients with ACS and MI, younger persons were more likely to experience clusters with the most symptoms. Older adults were more likely to experience clusters with the lowest number of symptoms and more diffuse and milder symptom clusters that are less reflective of classic ACS presentations. For HF patients, symptom clusters frequently included physical and emotional/cognitive components; edema clustered in only three studies. Symptom expression was congruent across geographical regions and cultures.
  
  
  
  The findings demonstrated similarities in symptom clusters during ACS, MI, and HF, despite multiple methods and analyses. These results may help clinicians to prepare at-risk patients for proper treatment-seeking and symptom self-management behaviors.
authors.affiliation: 1 University of Illinois at Chicago, College of Nursing, Chicago, IL, USA.
authors.forename: Holli A
authors.initials: HA
authors.lastname: DeVon
authors.affiliation: 1 University of Illinois at Chicago, College of Nursing, Chicago, IL, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Vuckovic
authors.affiliation: 1 University of Illinois at Chicago, College of Nursing, Chicago, IL, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Ryan
authors.affiliation: 2 University of Nebraska, College of Nursing, Lincoln, NE, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Barnason
authors.affiliation: 1 University of Illinois at Chicago, College of Nursing, Chicago, IL, USA.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Zerwic
authors.affiliation: 2 University of Nebraska, College of Nursing, Lincoln, NE, USA.
authors.forename: Bunny
authors.initials: B
authors.lastname: Pozehl
authors.affiliation: 2 University of Nebraska, College of Nursing, Lincoln, NE, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Schulz
authors.affiliation: 2 University of Nebraska, College of Nursing, Lincoln, NE, USA.
authors.forename: Yaewon
authors.initials: Y
authors.lastname: Seo
authors.affiliation: 2 University of Nebraska, College of Nursing, Lincoln, NE, USA.
authors.forename: Lani
authors.initials: L
authors.lastname: Zimmerman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D001026:Coronary Artery Bypass / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Symptom clusters; acute coronary syndrome; coronary heart disease; heart failure; myocardial infarction; symptoms