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Symptom Clusters in Adults With Chronic Atrial Fibrillation

Streur, Megan RN, MN; Ratcliffe, Sarah J. PhD; Ball, Jocasta PhD; Stewart, Simon PhD, RN; Riegel, Barbara PhD, RN

Journal of Cardiovascular Nursing: May/June 2017 - Volume 32 - Issue 3 - p 296–303
doi: 10.1097/JCN.0000000000000344
ARTICLES: Symptom Clusters

Background: Symptom clusters have not previously been explored among individuals with atrial fibrillation of any type.

Objective: The purpose of this study is to determine the number of symptom clusters present among adults with chronic atrial fibrillation and to explore sociodemographic and clinical factors potentially associated with cluster membership.

Methods: This was a cross-sectional secondary data analysis of 335 Australian community-dwelling adults with chronic (recurrent paroxysmal, persistent, or permanent) atrial fibrillation. We used self-reported symptoms and agglomerative hierarchical cluster analysis to determine the number and content of symptom clusters present.

Results: There were slightly more male (52%) than female participants, with a mean (SD) age of 72 (11.25) years. Three symptom clusters were evident, including a vagal cluster (nausea and diaphoresis), a tired cluster (fatigue/lethargy, weakness, syncope/dizziness, and dyspnea/breathlessness), and a heart cluster (chest pain/discomfort and palpitations/fluttering). We compared patient characteristics among those with all the symptoms in the cluster, those with some of the symptoms in the cluster, and those with none of the symptoms in the cluster. The only statistically significant differences were in age, gender, and the use of antiarrhythmic medications for the heart cluster. Women were more likely to have the heart symptom cluster than men were. Individuals with all of the symptoms in the heart cluster were younger (69.6 vs 73.7 years; P = .029) than those with none of the symptoms in the heart cluster and were more likely to be on antiarrhythmic medications.

Conclusion: Three unique atrial fibrillation symptom clusters were identified in this study population.

Megan Streur, RN, MN Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia.

Sarah J. Ratcliffe, PhD Associate Professor, Division of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Jocasta Ball, PhD Postdoctoral Research Fellow, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.

Simon Stewart, PhD, RN Professor, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.

Barbara Riegel, PhD, RN Professor, School of Nursing, University of Pennsylvania, Philadelphia.

The research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number NRT32 9356-06A1 and F31NR015687. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Standard Versus Atrial Fibrillation Specific Management Strategy Trial was funded by the National Health and Medical Research Council of Australia (NHMRC). J.B. and S.S. are supported by the NHMRC and J.B. is also supported by the National Heart Foundation of Australia.

The authors have no conflicts of interest to disclose.

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Correspondence Megan Streur, RN, MN, 418 Curie Blvd, Philadelphia, PA 19104-4217 (mstreur@nursing.upenn.edu).

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