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Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception

Jurgens, Corrine Y. PhD, RN, ANP, FAHA, FAAN; Lee, Christopher S. PhD, RN, FAHA, FAAN; Riegel, Barbara PhD, RN, FAHA, FPCNA, FAAN

Journal of Cardiovascular Nursing: March/April 2017 - Volume 32 - Issue 2 - p 140–147
doi: 10.1097/JCN.0000000000000320
ARTICLES: Heart Failure

Background: Symptoms are known to predict survival among patients with heart failure (HF), but discrepancies exist between patients’ and health providers’ perceptions of HF symptom burden.

Objective: The purpose of this study is to quantify the internal consistency, validity, and prognostic value of patient perception of a broad range of HF symptoms using an HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v. 3.

Methods: Factor analysis of the HF Somatic Perception Scale was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire. Divergent validity was examined using the Self-care of HF Index self-care management score. One-year survival based on HF Somatic Perception Scale scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics, and lab values.

Results: The sample was 63% male, 85% white, 67% functionally compromised (New York Heart Association class III–IV) with a mean (SD) age of 63 (12.8) years. Internal consistency of the HF Somatic Perception Scale was α = .90. Convergent (r = −0.54, P < .0001) and divergent (r = 0.18, P > .05) validities were supported. Controlling for Seattle HF scores, HF Somatic Perception Scale was a significant predictor of 1-year survival, with those most symptomatic having worse survival (hazard ratio, 1.012; 95% confidence interval, 1.001–1.024; P = .038).

Conclusions: Perception of HF symptom burden as measured by the HF Somatic Perception Scale is a significant predictor of survival, contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms, may be useful in evaluating therapeutic outcomes and predicting event-free survival.

Corrine Y. Jurgens, PhD, RN, ANP, FAHA, FAAN Associate Professor, School of Nursing, Stony Brook University, New York.

Christopher S. Lee, PhD, RN, FAHA, FAAN Associate Professor, School of Nursing, Oregon Health & Science University, Portland.

Barbara Riegel, PhD, RN, FAHA, FPCNA, FAAN Edith Clemmer Steinbright Professor of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia.

This work was supported by the Office of Research on Women’s Health and the National Institute of Child Health and Human Development (HD043488-08 [PI: CSL]) and by awards from the American Heart Association (11BGIA7840062 [PI: CSL]; 07SDG0730128N [PI: CYJ]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or American Heart Association.

The authors have no funding or conflicts of interest to disclose.

Correspondence Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHA, FAAN, School of Nursing, Stony Brook University. HSC L2-246 Stony Brook, NY 11794-8240 (

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