The changes of core symptom clusters in patients with acute heart failure during admission and vulnerable phase：a longitudinal study

doi:10.3761/j.issn.0254-1769.2022.17.010

Abstract

Abstract:

Objective To longitudinally investigate the characteristics of symptom clusters in patients with acute heart failure（AHF） from admission to vulnerable phase,in order to provide a basis for medical staff to implement targeted symptom management. Methods A prospective study design was adopted to facilitate the selection of 265 AHF patients hospitalized in the Cardiology Department of a tertiary hospital in Zhengzhou from November 2019 to November 2020. On the 3rd day of admission and the vulnerable phase（2 months after discharge,3 months after discharge）,the Chinese version of the Memorial Symptom Assessment Scale-Heart Failure was used for investigation. Exploratory factor analysis was performed on the symptom incidence≥40% at 3 time points to extract the symptom clusters,and the statistical description was carried out. Results AHF patients had 4 symptom clusters on the 3rd day of admission,namely acute blood volume overload symptom cluster,psycho-emotional symptom cluster,fatigue symptom cluster,peripheral and lung congestion symptom cluster. There were 3 symptom clusters in 2 months after discharge,namely rest-related symptom cluster,heart and tissue ischemia symptom cluster,chest pain/tightness-tension symptom cluster. There were 3 symptom clusters in 3 months after discharge,namely psycho-emotional symptom cluster,sleep difficulty-dry mouth symptom cluster,and fatigue symptom cluster. Conclusion The symptom clusters of AHF patients show dynamic changes at different time points;fatigue symptoms appear steadily;the symptom clusters are relatively serious at admission. However,the symptom clusters in the vulnerable phase cannot be ignored. Medical staff can take targeted interventions according to the characteristics of the symptom clusters in different periods.

Key words: Heart Failure, Vulnerable Phase, Symptom Cluster, Exploratory Factor Analysis, Longitudinal Study, Nursing Care

摘要：

目的纵向探讨急性心力衰竭（acute heart failure,AHF）患者从入院时到易损期不同时期症状群的特点,以期为医护人员实施针对性的症状管理提供依据。方法采用前瞻性研究设计,便利选取2019年11月—2020年11月在郑州市某三级甲等医院心内科住院的265例AHF患者,分别在患者入院第3天、出院后2个月和出院后3个月,使用中文版Memorial心力衰竭症状评估量表进行调查,且对3个时间点症状发生率≥40%的症状进行探索性因子分析提取症状群,并进行统计描述。结果 AHF患者入院第3天有4个症状群,分别是急性血容量负荷过重症状群、心理情绪症状群、疲乏症状群和外周及肺部淤血症状群;出院后2个月有3个症状群,分别是休息相关症状群、心脏及组织缺血症状群和胸痛/胸闷-紧张症状群;出院后3个月有3个症状群,分别是心理情绪症状群、睡眠困难-口干症状群和疲乏症状群。结论 AHF患者的症状群在不同时间点呈现动态变化的特点,疲乏症状稳定出现,入院时症状群较为严重,但是易损期的症状群也不容忽视,医护人员可以根据不同时期的症状群特征,采取针对性的干预措施。

关键词: 心力衰竭, 易损期, 症状群, 探索性因子分析, 纵向研究, 护理

ZHENG Gaigai, YANG Qiaofang, YIN Yue, CHEN Cancan, SHI Zhenyu, ZHANG Yanjie, HAO Ruonan, TIAN Huan, LIU Yancun. The changes of core symptom clusters in patients with acute heart failure during admission and vulnerable phase：a longitudinal study[J]. Chinese Journal of Nursing, 2022, 57(17): 2109-2115.

郑改改, 杨巧芳, 殷月, 陈参参, 石贞玉, 张艳杰, 蒿若楠, 田焕, 刘艳存. 急性心力衰竭患者入院时及易损期核心症状群的纵向研究[J]. 中华护理杂志, 2022, 57(17): 2109-2115.

Figures/Tables 4

Table 1 The incidence and severity of symptoms at each time point in patients with AHF

Table 2 Factor load matrix after symptom rotation on day 3 of AHF admission（n=265）

Table 3 Factor load matrix after symptom rotation at 2 months after AHF patient discharge（n=216）

Table 4 Factor load matrix after symptom rotation at 3 months after AHF patient discharge（n=165）

References 30

[1]	Crespo-Leiro MG, Anker SD, Maggioni AP, et al. Heart Failure Association(HFA) of the European Society of Cardiology (ESC). European Society of Cardiology Heart Failure Long-Term Registry(ESC-HF-LT):1-year follow-up outcomes and differences across regions[J]. Eur J Heart Fail, 2016, 18(6):613-625. DOI PMID
[2]	Lokker ME, Gwyther L, Riley JP, et al. The prevalence and associated distress of physical and psychological symptoms in patients with advanced heart failure attending a South African medical center[J]. J Cardiovasc Nurs, 2016, 31(4):313-322. DOI URL
[3]	Wilson J, Mcmillan S. Symptoms experienced by heart failure patients in hospice care[J]. J Hosp Palliat Nurs, 2013, 15(1):13-21. DOI URL
[4]	Alpert CM, Smith MA, Hummel SL, et al. Symptom burden in heart failure:assessment,impact on outcomes,and management[J]. Heart Fail Rev, 2017, 22(1):25-39. DOI PMID
[5]	Lum HD, Carey EP, Fairclough D, et al. Burden some physical and depressive symptoms predict heart failure-specific health status over one year[J]. J Pain Symptom Manage, 2016, 51(6):963-970. DOI URL
[6]	Stewart D, Mcpherson ML. Symptom management challenges in heart failure:pharmacotherapy considerations[J]. Heart Fail Rev, 2017, 22(5):525-534. DOI PMID
[7]	Greene SJ, Fonarow GC, Vaduganathan M, et al. The vulnerable phase after hospitalization for heart failure[J]. Nat Rev Cardiol, 2015, 12(4):220-229. DOI URL
[8]	王泽泉, 吴茂春, 李漫漫, 等. 心力衰竭症状群的研究进展[J]. 护理学杂志, 2017, 32(3):110-113.
	Wang ZQ, Wu MC, Li MM, et al. Symtom clusters of cardiac failure:a literature review[J]. J Nurs Sci, 2017, 32(3):110-113.
[9]	Khan L, Cramarossa G, Lemke M, et al. Symptom clusters using the Spitzer quality of life index in patients with brain metastases--a reanalysis comparing different statistical methods[J]. Support Care Cancer, 2013, 21(2):467-473. DOI URL
[10]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Chinese Cardiovascular Disease Branch,the Heart Failure Professional Committee of the Chinese Medical Doctor Association,Editorial Committee of the Chinese Journal of Cardiovascular Disease. Chinese guidelines for the diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789.
[11]	Zambroski CH, Moser DK, Bhat G, et al. Impact of symptom prevalence and symptom burdenon quality of life in patients with heart failure[J]. Eur J Cardiovasc Nurs, 2005, 4(3):198-206. DOI URL
[12]	郭金玉, 吕蓉, 张健, 等. 中文版Memorial心力衰竭症状评估量表的信效度评定[J]. 中华护理杂志, 2014, 49(12):1448-1452.
	Guo JY, Lü R, Zhang J, et al. Reliability and validity of the Chinese version of Memorial Symptom Assessment Scale-Heart Failure[J]. Chin J Nurs, 2014, 49(12):1448-1452.
[13]	Jurgens CY, Moser DK, Armola R, et al. Symptom clusters of heart failure[J]. Res Nurs Health, 2009, 32(5):551-560. DOI URL
[14]	宣凡馨, 郭金玉, 李峥. 心力衰竭患者住院前症状群的研究[J]. 中华护理杂志, 2015, 50(3):292-295.
	Xuan FX, Guo JY, Li Z. Analysis of heart failure symptom clusters before hospitalization to indicate patients getting timely treatment[J]. Chin J Nurs, 2015, 50(3):292-295.
[15]	Moser DK, Lee KS, Wu JR, et al. Identification of symptom clusters among patients with heart failure:an international observational study[J]. Int J Nurs Stud, 2014, 51(10):1366-1372. DOI URL
[16]	Huang TY, Moser DK, Hwang SL. Identification,associated factors,and prognosis of symptom clusters in Taiwanese patient:with heart failure[J]. J Nurs Res, 2018, 26(1):60-67.
[17]	杨贝贝, 郑战战, 吴圣佳, 等. 慢性稳定性心力衰竭患者症状群分类的研究[J]. 中国护理管理, 2018, 18(2):185-191.
	Yang BB, Zheng ZZ, Wu SJ, et al. Identification of symptom clusters in patients with chronic stable heart failure[J]. Chin Nurs Manag, 2018, 18(2):185-191.
[18]	Park J, Moser DK, Griffith K, et al. Exploring symptom clusters in people with heart failure[J]. Clin Nurs Res, 2019, 28(2):165-181. DOI URL
[19]	李庆印, 李峥, 康晓凤, 等. 成人急性心力衰竭护理实践指南[J]. 中国护理管理, 2016, 16(9):1179-1188.
	Li QY, Li Z, Kang XF, et al. Practice guidelines for the care of acute heart failure in adults[J]. Chin Nurs Manag, 2016, 16(9):1179-1188.
[20]	周京敏, 崔晓通, 葛均波. 中国心力衰竭的流行病学概况[J]. 中华心血管病杂志, 2015, 43(12):1018-1021.
	Zhou JM, Cui XT, Ge JB. Epidemiological overview of heart failure in China[J]. Chin J Cardiol, 2015, 43(12):1018-1021.
[21]	Redeker NS, Jeon S, Andrews L, et al. Effects of cognitive behavioral therapy for insomnia on sleep-related cognitions among patients with stable heart failure[J]. Behav Sleep Med, 2019, 17(3):342-354. DOI PMID
[22]	孙欣, 周荣, 钱娟, 等. 慢性心力衰竭患者应用放松式呼吸训练的效果[J]. 实用临床医药杂志, 2019, 23(2):37-39,43.
	Sun X, Zhou R, Qian J, et al. Effect of relaxed respiratory training for chronic heart failure patients[J]. J Clin Med Pract, 2019, 23(2):37-39,43.
[23]	郑改改, 张艳杰, 杨巧芳, 等. 慢性心力衰竭病人非药物症状管理方案的构建[J]. 护理研究, 2021, 35(15):2637-2643.
	Zheng GG, Zhang YJ, Yang QF, et al. Construction of non-drug symptom management plan for patients with chronic heart failure[J]. Chin Nurs Res, 2021, 35(15):2637-2643.
[24]	宣凡馨, 李峥, 康晓凤, 等. 心力衰竭患者症状群的纵向研究[J]. 中华护理杂志, 2017, 52(12):1450-1456.
	Xuan FX, Li Z, Kang XF, et al. Changes of heart failure sym-ptom clusters during the course of disease:a longitudinal study[J]. Chin J Nurs, 2017, 52(12):1450-1456.
[25]	Hu Y, Jiang J, Xu L, et al. Symptom clusters and quality of life among patients with chronic heart failure:a cross-sectional study[J]. Jpn J Nurs Sci, 2021, 18(1):e12366.
[26]	Eisele M, Rakebrandt A, Boczor S, et al. Factors associated with general practitioners’ awareness of depression in primary care patients with heart failure:baseline-results from the observational RECODE-HF study[J]. BMC Fam Pract, 2017, 18(1):71-82. DOI URL
[27]	Cully JA, Jimenez DE, Ledoux TA, et al. Recognition and treatment of depression and anxiety symptoms in heart failure[J]. Prim Care Companion J Clin Psychiatry, 2009, 11(3):103-109. DOI URL
[28]	盛春. 慢性心力衰竭合并抑郁研究进展[J]. 护理研究, 2021, 35(19):3478-3482.
	Sheng C. Research progress of chronic heart failure complicated with depression[J]. Chin Nurs Res, 2021, 35(19):3478-3482.
[29]	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America[J]. Circulation, 2017, 136(6):e137-e161.
[30]	王乐民, 沈玉芹. 慢性稳定性心力衰竭运动康复中国专家共识[J]. 中华心血管病杂志, 2014, 42(9):714-720.
	Wang YM, Shen YQ. Chinese expert consensus on exercise rehabilitation of chronic stable heart failure[J]. Chin J Cardiol, 2014, 42(9):714-720.