| Objectives:Investigate the status of symptomatic,psychological and social support in hospitalized patients with heart failure(HF),describe the symptoms and experiences of patients with HF,group the selected symptoms into clusters,and try to explain the clinical significance of symptom clusters.The theory of unpleasant symptom analyzes the influencing factors(physiological,psychological,and environmental)of the symptom clusters among HF inpatients,describes the HF inpaitents’ quality of life,and analyzes the symptom clusters or related in:fluencing factors affecting the quality of life of inpatients with HF,which are clinical symptoms.Management and intervention provide evidence.Methods:Convenient sampling method was used to select all inpatients with HF in the cardiology department,respiratory department and ICU of a top hospital in Northest China from February 2017 to Novement 2017.All patients with heart failure who met the exclusion criteria and signed the informed consent form were enrolled.The questionnaire was collected in face-to-face were enrolled.The questionnaire consisted of five parts:General informatin Questionnaire,Heart Failure Memory Symptom Inventory,Hospital Anxiety Depression Scale,Social Support Rating Scale and Minnesota Heart Failure Quality of life Questionnaire.Using EpiData 3.1 software input data,SPSS 17.0 software for statistical analysis of the data.Descriptive analysis was conducted on general demographic characteristics,disease characteristics,symptom experience,symptom clusters,social support,anxiety and depression,and quality of life of the study subjects.The count data were described by percentage and measurement data.The symptom clusters of patients with hear failue using statistical methods of factor analysis,symptom clusters and quality of life factors using single factor analysis and multiple stepwise regression method.Correlation analysis using Spearment correlation coefficient method.Results:1.A total of 210 hospitalized patients with HF were surveyed,200 questionnaires were returned(95.2%),and 165 valid questionnaires(82.5%).The hospitalized patients with heart failure had an anxiety score of 10.71±3.11,a depression score of 10.41 ±3.21,a subjective support of social support of 17.90±3.69,an objective support of 10.26±1.60,a support utility of 6.76±2.02,and a total social support of 34.47.±6.56.2.The five symptoms with the highest incidence rate of HF hospitalization were:difficulty in sleep(80%),dyspnea when lying down(78.8%),night time sleep awakening(78.2%),shortness of breath(77.6%),palpitations(fat palpitations,77.6%).The severity scores ranged from 1.77±0.79 to 3.18±0.56,The five most severe symptoms were:difficulty in sleep(3.05±0.63),irritability/no spirit(2.85±0.70),nighttime sleep arousal(2.85±0.63),Dyspnea(2.82±0.81)and palpitation(2.69±0.68)were found when lying flat.The symptomatic scores of each symptom were 3.28±0.62～1.53±0.71.The five most troublesome symptoms were:nighttime sleep arousal(3.38±0.72),difficulty in sleep(3.16±0.54),shortness of breath(3.03±0.66),and arms or leg edema(3.02 ± 0.82),palpitations(2.94 ± 0.53).3.Factor analysis of symptoms with an incidence>40%,resulting in four clusters of symptoms:discomfort clusters(dizziness,dry mouth,sweating,boring/nothing);symptomatic cluster of bruises(palpitation,shortness of breath,legs or arms)Edema);Symptoms of sleep disorders(wake up at night,difficulty sleeping,difficulty breathing with lying down);mood clusters(lack of appetite,anxiety,feelings of stress).4.The influencing factors among inpatients of HF with Theory of Unpleasant Symptoms were:etiology of coronary heart disease,marital status,drinking history,and whether they regularly used anti-heart failure drugs before admission;Factors influencing the symptoms of sleep disorders include:hyperuricemia Complications,hyperlipidemia complications,hypertension complications,pulmonale etiology,ejection fraction;Factors affecting the congestion syndrome group include:NYHA function,pulmonary heart disease etiology,hypertension cause;affect the emotional symptoms group The factors are:hypertension complications,social support,depression,diabetes.The overall quality of life score of hospitalized patients with HF was 77.26±6.65,with a score of 31.43±3.55 for somatic state,15.81 ±2.61 for emotional change,and 29.50±4.02 for other areas.Three symptom clusters were significantly associated with quality of life in the four symptom clusters:dyspnea syndrome cluster(r=0.447),bruising syndrome clusters(r=0.274),and emotional symptom clusters r=0.274(P<0.05).5.The overall quality of life score of hospitalized patients with HF was 77.26±6.65,with a score of 31.43±3.55 for somatic state,15.81 ±2.61 for emotional change,and 29.50±4.02 for other areas.Three symptom clusters were significantly associated with quality of life in the four symptom cluster:dyspnea syndrome cluster r=0.447,bruising syndrome cluster r=0.274,and emotional symptom cluster(r=0.274)(P<0.05).6.Multivariate stepwise regression analysis showed that the factors affecting the quality of life of hospitalized patients with HF include five factors:arrhythmia complications,sleep disorder symptoms,hospitalization for HF,discomfort syndrome,and social support in the past year.However,other relevant factors and symptom clusters did not have statistical significance for the quality of life of patients.Conclusion:1.Symptoms of HF hospitalized patients are high and many symptoms coexist.Among them,sleep disturbance,edema,lack of appetite and other symptoms are more severe than those of the severity.2.There are four symptom groups in hospitalized patients with HF:uncomfortable symptoms group,bruising symptom group,sleep disorder symptom group and emotional symptom group.Among them,the mean score of the sleep disorder symptom group is the highest.3.This study explored the influencing factors of the symptomatic group of hospitalized patients with HF,among which the factors affecting the symptoms of the disease include the cause of coronary heart disease,marital status,drinking history,and whether the patients were regularly taking anti-heart failure drugs before admission;The influencing factors were all patients’ disease factors,including high ureaemia complications,hyperlipidemia complications,hypertensive complications,cor pulmonale etiology,and ejection fraction;NYHA function was associated with the symptoms of congestion.The causes of pulmonary heart disease and the causes of hypertension are three kinds;there are four kinds of hypertension complications,social support,depression,and diabetes causes that affect the emotional symptoms of patients with HF.4.The higher score of the quality of life questionnaire indicates that the quality of life of the patient is lower.Factors affecting the quality of life of hospitalized patients with HF include sleep disorder symptom cluster,hypertension causes,and cardiomyopathy etiology. |
