Abstract 13604: Physical and Affective Symptom Clusters Are Strongly Associated in Heart Failure

Abstract

Introduction: The syndrome of heart failure (HF) is a constellation of both physical and affective symptoms. How physical and affective symptom clusters are associated, however, is not well understood. Hypothesis: There is a strong association between physical symptom clusters and affective symptom clusters among adults with moderate to advanced HF. Methods: This was a secondary analysis of combined data collected during two prospective cohort studies of symptoms among adults with moderate to advanced HF. Physical symptoms of dyspnea and wake disturbances were measured with the Heart Failure Somatic Perception Scale Dyspnea subscale (HFSPS-D) and the Epworth Sleepiness Scale (ESS), respectively. Affective symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Brief Symptom Inventory Anxiety subscale (BSIANX), respectively. Physical and affective symptoms were clustered separately using latent mixture modeling and then compared using cross classification modeling and traditional comparative statistics (i.e. student’s t, Kendall’s tau-b and chi-square tests). Results: The average age of the sample (n=291) was 56.7±13.3 years, and most were male (61.9%). A majority of subjects were classified as NYHA Class III HF (56.4%), and most had non-ischemic etiology (65.2%). Two physical symptom clusters (severe physical (26.3%) and mild physical (73.7%); dyspnea t=7.35, p<0.001; wake disturbances t=16.80, p<0.001) and two affective symptom clusters (severe affective (21.2%) and mild affective (78.8%); depression t=22.1, p<0.001; anxiety t=7.87, p<0.001) were identified in a model with good fit (entropy=0.80). Subjects with severe physical symptoms were more likely to have severe than mild affective symptoms, and those with mild physical symptoms were more likely to have mild than severe affective symptoms (χ2=106.8, p<0.001; tau b=0.62). Conclusions: There is a strong association between physical and affective symptom clusters among adults with moderate to advanced HF that may be helpful in identifying adults with HF at risk for multiple, co-occurring symptoms.