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Cluster Analysis of Elderly Cardiac Patients' Prehospital Symptomatology

Lindgren, Teri G.; Fukuoka, Yoshimi; Rankin, Sally H.; Cooper, Bruce A.; Carroll, Diane; Munn, Yvonne L.

doi: 10.1097/01.NNR.0000280654.50642.1a

Background: Chest pain routinely brings patients into the healthcare system, and elderly patients may present with more complex symptoms presaging ischemic heart changes than do younger patients.

Objective: To examine, using cluster analysis, how elderly patients experiencing an ischemic coronary heart disease cluster based on presenting symptoms in the week before hospitalization and how they vary in terms of their general physical and mental health, mood states, and quality of life.

Methods: Elderly (age ≥65 years), unpartnered patients (N = 247) admitted with ischemic coronary heart disease to one of five university medical centers were inducted into a clinical trial; only baseline data are reported. Interviews assessed cardiac symptoms, medical history, general physical and mental health, mood states, and quality of life. Patients were clustered (grouped) using squared Euclidean distances and weighted average linkage. Characteristics of patients were examined using analysis of variance and chi-squared analyses.

Results: Three clusters (groups) were identified: (a) Classic Acute Coronary Syndrome (severe ischemic pain; 22%), (b) Weary (severe fatigue, sleep disturbance, and shortness of breath; 29%), and (c) Diffuse Symptoms (mild symptomatology; 49%). Post hoc tests revealed that the Weary group was more likely to have a history of heart failure; they also exhibited significantly more psychological distress and lower quality of life than the other subgroups.

Conclusion: Cluster analysis proved useful in grouping patients based on their symptom experience, but further research is needed to clarify the relationships among identified symptoms, psychological distress, and health outcomes; develop interventions for Weary patients; and extend the findings of this study.

Teri G. Lindgren, PhD, MPH, RN, is Assistant Adjunct Professor; Yoshimi Fukuoka, PhD, RN, is Assistant Adjunct Professor; Sally H. Rankin, PhD, RN, FAAN, is Chair, Family Health Care Nursing; and Bruce A. Cooper, PhD, is Senior Statistician, University of California, San Francisco.

Diane Carroll, PhD, APRN, BC, is Clinical Nurse Specialist; and Yvonne L. Munn is Nurse Researcher, Massachusetts General Hospital, Boston.

Accepted for publication July 24, 2007.

This study was supported by the following grants: NINR R01 NR005205 for Drs. Rankin and Carroll, NIH T32 NR07088 symptom management postdoctoral fellowships for Drs. Lindgren and Fukuoka, and NICHD 9K12 HD052163-06 and the University of California, San Francisco Office of Research on Women's Health for Dr. Fukuoka.

Corresponding author: Teri G. Lindgren, PhD, MPH, RN, University of California, San Francisco, Box 0606, 2 Koret Way, Nursing 431M, San Francisco, CA 94143-0606 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.