A mixed methods study of symptom perception in patients with chronic heart failure

Abstract

Background: Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF.

Methods: We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months.

Results: In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received.

Conclusion: Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.

Keywords: Delay; Heart failure; Self-care; Symptom perception; decision-making; fluid retention; mixed methods; social support.

Figure

18 study participants had OptiVol data and reports of fluid retention available for analysis. Of these, 7 participants experienced considerable and highly variable thoracic fluid congestion over the 3 months. This is illustrated in the top figure showing that the fluid index rises and lowers in a variable fashion. In the bottom figure, we show the 11 who experienced consistently limited congestion and little variability over 3 months. These 11 had no major congestion events.