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Journal of Cardiovascular Nursing:
doi: 10.1097/JCN.0000000000000175
Feature Article: PDF Only

Symptom-Hemodynamic Mismatch and Heart Failure Event Risk.

Lee, Christopher S. PhD, RN, FAHA; Hiatt, Shirin O. MPH, MS, RN; Denfeld, Quin E. BSN, RN; Mudd, James O. MD; Chien, Christopher MD; Gelow, Jill M. MD, MPH

Published Ahead-of-Print
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Abstract

Background: Heart failure (HF) is a heterogeneous condition of both symptoms and hemodynamics.

Objective: The goals of this study were to identify distinct profiles among integrated data on physical and psychological symptoms and hemodynamics and quantify differences in 180-day event risk among observed profiles.

Methods: A secondary analysis of data collected during 2 prospective cohort studies by a single group of investigators was performed. Latent class mixture modeling was used to identify distinct symptom-hemodynamic profiles. Cox proportional hazards modeling was used to quantify difference in event risk (HF emergency visit, hospitalization, or death) among profiles.

Results: The mean age (n = 291) was 57 +/- 13 years, 38% were female, and 61% had class III/IV HF. Three distinct symptom-hemodynamic profiles were identified: 17.9% of patients had concordant symptoms and hemodynamics (ie, moderate physical and psychological symptoms matched the comparatively good hemodynamic profile), 17.9% had severe symptoms and average hemodynamics, and 64.2% had poor hemodynamics and mild symptoms. Compared with those in the concordant profile, both profiles of symptom-hemodynamic mismatch were associated with a markedly increased event risk (severe symptoms hazards ratio, 3.38; P = .033; poor hemodynamics hazards ratio, 3.48; P = .016).

Conclusions: A minority of adults with HF have concordant symptoms and hemodynamics. Either profile of symptom-hemodynamic mismatch in HF is associated with a greater risk of healthcare utilization for HF or death.

(C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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