Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms.
To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months.
Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale).
The mean age of the sample (n = 49) was 62years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90days reported on average, 130% higher dyspnea (p = 0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p = 0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p = 0.003; CI 19.1%, 257%) and 40% higher anxiety (p = 0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90days were also significantly associated with a clinically meaningful decrease in HRQOL (β = −16.16 ± 6.32; p = 0.01).
Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3months.
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- Heart Disease and Stroke Statistics-2017 Update: a report from the American Heart Association.Circulation. 2017; 135: e146-e603
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- A comparison of health-related quality of life between older adults with heart failure and healthy older adults.Heart Lung. 2007; 36: 16-24
- Dose-dependent relationship of physical and depressive symptoms with health-related quality of life in patients with heart failure.Eur J Cardiovasc Nurs. 2013; 12: 454-460
- Water and sodium in heart failure: a spotlight on congestion.Heart Fail Rev. 2015; 20: 13-24
- Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels.PLoS One. 2014; 9 (e96325-e96325)
- Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J. 2005; 149: 209-216
- Threshold crossing of device-based intrathoracic impedance trends identifies relatively increased mortality risk.Eur Heart J. 2012; 33: 2189-2196
- Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure.Eur J Heart Fail. 2014; 16: 419-425
- Identification of factors predictive of hospital readmissions for patients with heart failure.Heart Lung. 2003; 32: 88-99
- Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure.Eur J Cardiovasc Nurs. 2005; 4: 198-206
- Somatic awareness, uncertainty, and delay in care-seeking in acute heart failure.Res Nurs Health. 2006; 29: 74-86
- Profiles of self-care management versus consulting behaviors in adults with heart failure.Eur J Cardiovasc Nurs. 2015; 14: 63-72
- Delayed hospital presentation in acute decompensated heart failure: clinical and patient reported factors.Heart Lung. 2013; 42: 281-286
- Why do elders delay responding to heart failure symptoms.Nurs Res. 2009; 58: 274-282
- Symptoms in heart failure correlate poorly with objective haemodynamic parameters.Int J Clin Pract. 2012; 66: 1224-1229
- Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life.J Card Fail. 2006; 12: 87-92
- Dissociation between hemodynamic changes and symptom improvement in patients with advanced congestive heart failure.Eur J Heart Fail. 2002; 4: 297-304
- Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM.Eur J Heart Fail. 2007; 9: 83-91
- Quality of life and chronic heart failure therapy guided by natriuretic peptides: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study.Am Heart J. 2012; 164 (e791): 793-799
- Intrathoracic impedance vs daily weight monitoring for predicting worsening heart failure events: results of the Fluid Accumulation Status Trial (FAST).Congest Heart Fail. 2011; 17: 51-55
- Symptom-hemodynamic mismatch and heart failure event risk.J Cardiovasc Nurs. 2015; 30: 394-402
- Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization.Circulation. 2005; 112: 841-848
- Intrathoracic impedance monitoring to predict decompensated heart failure.Am J Cardiol. 2007; 99: 554-557
- Changes in intrathoracic impedance are associated with subsequent risk of hospitalizations for acute decompensated heart failure: clinical utility of implanted device monitoring without a patient alert.J Card Fail. 2009; 15: 475-481
- A critical link between heart failure self-care and intrathoracic impedance.J Cardiovasc Nurs. 2011; 26: E20-E26
- Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) Measurement System.J Pain Symptom Manage. 1997; 13: 63-74
- Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales.Health Qual Life Outcomes. 2007; 5 (12-12)
- Validation of the Functional Assessment of Chronic Illness Therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis.J Rheumatol. 2005; 32: 811-819
- Fatigue in cancer patients compared with fatigue in the general United States population.Cancer. 2002; 94: 528-538
- Psychometric testing of the heart failure somatic awareness scale.J Cardiovasc Nurs. 2006; 21: 95-102
- Psychometric Analysis of the Heart Failure Somatic Perception Scale as a measure of patient symptom perception.J Cardiovasc Nurs. 2015;
- Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.JAMA. 1999; 282: 1737-1744
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(R)): depression, anxiety, and anger.Assessment. 2011; 18: 263-283
- The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- Cognitive function and self-care management in older patients with heart failure.Eur J Cardiovasc Nurs. 2014; 13: 277-284
- Development and validation of a short version of the Kansas City Cardiomyopathy Questionnaire.Circ. 2015; 8: 469-476
- A correlational study of illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.J Nurs Res. 2014; 22: 136-145
- The implications of living with heart failure; the impact on everyday life, family support, co-morbidities and access to healthcare: a secondary qualitative analysis.BMC Fam Pract. 2016; 17: 139
- A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions.J Card Fail. 2011; 17: 413-419
- A mixed methods study of symptom perception in patients with chronic heart failure.Heart Lung. 2018;
- Why does chronic heart failure cause breathlessness and fatigue.Prog Cardiovasc Dis. 2007; 49: 366-384
- Fatigue with systolic heart failure.J Cardiovasc Nurs. 2009; 24: 410-417
- Congestion in acute heart failure syndromes: an essential target of evaluation and treatment.Am J Med. 2006; 119: S3-S10
- Fatigue in older adults with stable heart failure.Heart Lung. 2008; 37: 122-131
- A Systematic review of biological mechanisms of fatigue in chronic illness.Biol Res Nurs. 2018; 20: 410-421
- Measuring bias in self-reported data.Int J Behav Healthc Res. 2011; 2: 320-332
- Physical and psychological symptom biomechanics in moderate to advanced heart failure.J Cardiovasc Nurs. 2015; 30: 346-350
- Gender-specific physical symptom biology in heart failure.J Cardiovasc Nurs. 2015; 30: 517-521
- Exploring the relationship between beta-adrenergic receptor kinase-1 and physical symptoms in heart failure.Heart Lung. 2018; 47: 281-284
- Physical and psychological symptom profiling and event-free survival in adults with moderate to advanced heart failure.J Cardiovasc Nurs. 2013; 00: 1-9
- Identification of symptom clusters among patients with heart failure: an international observational study.Int J Nurs Stud. 2014; 51: 1366-1372
Published online: January 02, 2019
Accepted: December 4, 2018
Received in revised form: November 7, 2018
Received: August 12, 2018
☆Funding: This work was supported by the National Institute of Nursing Research (F31NR016660). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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