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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

doi: 10.1097/JCN.0000000000000175
Articles

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.

Christopher S. Lee, PhD, RN, FAHA Associate Professor, School of Nursing and Knight Cardiovascular Institute, Oregon Health & Science University, Portland.

Shirin O. Hiatt, MPH, MS, RN Research Project Coordinator, School of Nursing, Oregon Health & Science University, Portland.

Quin E. Denfeld, BSN, RN PhD Student and Research Associate, School of Nursing, Oregon Health & Science University, Portland.

James O. Mudd, MD Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland.

Christopher Chien, MD Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland.

Jill M. Gelow, MD, MPH Assistant Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland.

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) and by an award from the American Heart Association (11BGIA7840062). 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 conflicts of interest to disclose.

Correspondence Christopher S. Lee, PhD, RN, FAHA, School of Nursing, Oregon Health & Science University, Mail code: SN-2N 3455 SW US Veterans Hospital Road, Portland, OR 97239-2941 (csleern@gmail.com).

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