Psychosocial Factors Moderate the Relationship between Clinical Status and Dyspnea in Both Taiwanese and American Heart Failure Patients

Abstract

Introduction: Dyspnea is the most common and distressing symptom of heart failure (HF) patients. Although psychosocial factors likely contribute to dyspnea, only clinical characteristics have been studied in HF. It is necessary to identify all factors influencing dyspnea so that effective symptom management interventions can be developed. Specific Aims: To determine and compare whether psychosocial factors moderate the relationship between clinical characteristics and dyspnea in both Taiwanese (T) and American (Am) HF patients (pts). Method: Dyspnea and psychosocial variables (i.e., depression, anxiety, perceived control, and perceived social support) were compared between two groups of HF pts: 97 T (mean age 66.2 ± 12.1 yrs; 76% male; 28% NYHA III/IV) and 96 Am (mean age 61.6 ± 11.7 yrs; 74% male; 42% NYHA III/IV). Dyspnea was measured using the Modified Pulmonary Function Status and Dyspnea Questionnaire, depression and anxiety using the Brief Symptom Inventory, perceived control using the revised Control Attitudes Scale, and perceived social support using the Perceived Social Support Scale- Revised. Multi-sample LISREL analysis was used to test moderator effects across groups. Result: Dyspnea (11.36 ± 13.76 T, 12.17 ± 13.57 Am, p> .05), depression (0.57 ± 0.70 T, 0.58 ± 0.75 Am, p> .05), and anxiety (0.48 ± 0.60 T, 0.59 ± 0.68 Am, p> .05) in both groups were similar. Perceived control (47.59 ± 6.86 T, 54.01 ± 6.57 Am, p< .05) and perceived social support (44.16 ± 7.72 T, 68.32 ± 14.69 Am, p< .05) were rated better in Am compared to T HF patients. In Am patients, depression (β=0.76, p< .05), anxiety (β=0.85, p< .05) and perceived social support (β=-0.03, p< .05) were moderators of the relationship between clinical status and dyspnea severity. In T patients, only perceived social support (β=0.08, p< .05) moderated the relationship between clinical variables and dyspnea. Conclusion: Although different psychosocial factors moderated the relationship of clinical factors and dyspnea severity in Am and T patients, it is clear that psychosocial factors play substantial roles in the dyspnea symptom experience in HF patients. Attention to these psychosocial factors may improve HF patients’ dyspnea.