title: Symptom clusters and quality of life among patients with advanced heart failure.
abstract: OBJECTIVE
  To identify symptom clusters among patients with advanced heart failure (HF) and the independent relationships with their quality of life (QoL).
  
  
  METHODS
  This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale (ESAS) and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hierarchical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities.
  
  
  RESULTS
  The patients were at an advanced age (82.9 ± 6.5 years). Three distinct symptom clusters were identified: they were the distress cluster (including shortness of breath, anxiety, and depression), the decondition cluster (fatigue, drowsiness, nausea, and reduced appetite), and the discomfort cluster (pain, and sense of generalized discomfort). These three symptom clusters accounted for 63.25% of variance of the patients' symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress (β = -0.635, P < 0.001), the decondition (β = -0.148, P = 0.01), and the discomfort (β = -0.258, P < 0.001) symptom clusters independently predicted their QoL.
  
  
  CONCLUSIONS
  This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Doris Sf
authors.initials: DS
authors.lastname: Yu
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Helen Yl
authors.initials: HY
authors.lastname: Chan
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Doris Yp
authors.initials: DY
authors.lastname: Leung
authors.affiliation: Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China.
authors.forename: Elsie
authors.initials: E
authors.lastname: Hui
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Janet Wh
authors.initials: JW
authors.lastname: Sit
keywords: Advanced heart failure; Palliative care model; Quality of life; Symptom clusters