Moser Debra K, Lee Kyoung Suk, Wu Jia-Rong, Mudd-Martin Gia, Jaarsma Tiny, Huang Tsuey-Yuan, Fan Xui-Zhen, Strömberg Anna, Lennie Terry A, Riegel Barbara
University of Kentucky, College of Nursing, United States.
University of Wisconsin, School of Nursing, United States.
Int J Nurs Stud. 2014 Oct;51(10):1366-72. doi: 10.1016/j.ijnurstu.2014.02.004. Epub 2014 Feb 28.
Virtually all patients with heart failure experience multiple symptoms simultaneously, yet clinicians and researchers usually consider symptoms in isolation. Recognizing and responding early to escalating symptoms is essential to preventing hospitalizations in heart failure, yet patients have considerable difficulty recognizing symptoms. Identification of symptom clusters could improve symptom recognition, but cultural differences may be present that must be considered.
To identify and compare symptom clusters in heart failure patients from the United States, Europe and Asia.
Cross-sectional, observational study.
In- and out-patient settings in three regions of the world: Asia (i.e., China and Taiwan); Europe (i.e., the Netherlands and Sweden); and the United States.
A total of 720 patients with confirmed heart failure. Propensity scoring using New York Heart Association Classification was used to match participants from each of the three regions.
Symptoms were identified using the Minnesota Living with Heart Failure Questionnaire. To identify symptom clusters we used cluster analysis with the hierarchical cluster agglomerative approach. We used the Euclidean distance to measure the similarity of variables. Proximity between groups of variables was measured using Ward's method. The resulting clusters were displayed with dendrograms, which show the proximity of variables to each other on the basis of semi-partial R-squared scores.
There was a core group of symptoms that formed two comparable clusters across the countries. Dyspnea, difficulty in walking or climbing, fatigue/increased need to rest, and fatigue/low energy were grouped into a cluster, which was labeled as a physical capacity symptom cluster. Worrying, feeling depressed, and cognitive problems were grouped into a cluster, which was labeled as an emotional/cognitive symptom cluster. The symptoms of edema and trouble sleeping were variable among the countries and fell into different clusters.
Despite the diversity in cultures studied, we found that symptoms clustered similarly among the cultural groups. Identification of similar symptoms clusters among patients with heart failure may improve symptom recognition in both patients and healthcare providers.
几乎所有心力衰竭患者都会同时经历多种症状，但临床医生和研究人员通常孤立地考虑这些症状。早期识别并应对不断升级的症状对于预防心力衰竭患者住院至关重要，但患者在识别症状方面存在很大困难。识别症状群可能会改善症状识别，但必须考虑可能存在的文化差异。
识别并比较来自美国、欧洲和亚洲的心力衰竭患者的症状群。
横断面观察性研究。
世界三个地区的门诊和住院环境：亚洲（即中国和台湾）；欧洲（即荷兰和瑞典）；以及美国。
共有720例确诊心力衰竭患者。使用纽约心脏协会分级进行倾向评分，以匹配来自三个地区的参与者。
使用明尼苏达心力衰竭生活问卷识别症状。为了识别症状群，我们采用层次聚类凝聚法进行聚类分析。我们使用欧几里得距离来衡量变量的相似性。变量组之间的接近程度采用沃德法测量。生成的聚类用树状图展示，树状图根据半偏R平方得分显示变量之间的接近程度。
有一组核心症状在各国形成了两个可比的聚类。呼吸困难、行走或爬楼梯困难、疲劳/休息需求增加以及乏力/精力不足被归为一个聚类，被标记为身体能力症状群。担忧、情绪低落和认知问题被归为一个聚类，被标记为情绪/认知症状群。水肿和睡眠问题的症状在各国之间存在差异，归入不同的聚类。
尽管所研究的文化存在多样性，但我们发现不同文化群体中的症状聚类方式相似。识别心力衰竭患者中相似的症状群可能会改善患者和医护人员对症状的识别。
