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Symptom Profiles of Coronary Artery Bypass Surgery Patients at Risk for Poor Functioning Outcomes

Zimmerman, Lani PhD, RN, FAHA, FAAN; Barnason, Susan PhD, APRN-CNS, CEN, CCRN, FAHA; Young, Lufei BSN, RN; Tu, Chunhao PhD, Statistics; Schulz, Paula PhD, RN; Abbott, Amy A. PhD, RN

The Journal of Cardiovascular Nursing: July-August 2010 - Volume 25 - Issue 4 - p 292-300
doi: 10.1097/JCN.0b013e3181cfba00
ARTICLES: Special Topic: Symptom Clusters
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The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. The majority of the 226 subjects were married (86%), male (83%), and had a mean age of 71 (SD, 4.96) years. Eight symptoms were used in the model-based clustering method-shortness of breath, fatigue, depression, sleep disturbances, pain, swelling, anxiety, and appetite problems-and demonstrated that there were 3 patient clusters of symptom burden. Cluster 1 had low symptom burden on all 8 symptoms, cluster 3 had moderate symptom burden on all 8 symptoms, and cluster 2 had a combination of low (shortness of breath, fatigue, depression, pain, and anxiety) and moderate symptom burden (sleep problems, swelling, and appetite problems). Analyses of covariance revealed no significant cluster × time interactions for any of the variables. However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.

Lani Zimmerman, PhD, RN, FAHA, FAAN Professor, University of Nebraska Medical Center College of Nursing, Lincoln.

Susan Barnason, PhD, APRN-CNS, CEN, CCRN, FAHA Professor, University of Nebraska Medical Center College of Nursing, Lincoln.

Lufei Young, BSN, RN Doctoral Student, University of Nebraska Medical Center College of Nursing, Lincoln.

Chunhao Tu, PhD, Statistics Assistant Professor, College of Pharmacy, University of New England, Portland, Maine.

Paula Schulz, PhD, RN Assistant Professor, University of Nebraska Medical Center College of Nursing, Lincoln.

Amy A. Abbott, PhD, RN Assistant Professor, Creighton University School of Nursing, Omaha, Nebraska.

Correspondence Lani Zimmerman, PhD, RN, FAHA, FAAN, University of Nebraska Medical Center College of Nursing, 1230 O St, Suite 131, PO Box 880220, Lincoln, NE 68588-0220 (lzimmerm@unmc.edu).

© 2010 Lippincott Williams & Wilkins, Inc.