Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure
Open accessAbstract
BACKGROUND: Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions. AIMS: To examine the relationship between patterns of HF symptom variability, and HF event-free survival. METHODS: Patients with HF (N=71) rated HF symptoms daily for 30 days. Symptoms were rated on a 10 point scale anchored at the extreme ends by "worst symptom could be" and "best symptom could be". Patients were followed for an average of 1 year to track HF and cardiac rehospitalizations and all-cause mortality. RESULTS: Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality. CONCLUSION: Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms.
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Prioritizing symptom management in clinics could reduce hospital readmissions and reduce the costs of care.
“Prioritizing symptom management in clinics could reduce hospital readmissions and reduce the costs of care. 1 , 20”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [20]
The introductory text following the Abstract conclusion (page unavailable) says that hospitalizations account for most heart-failure care costs and that failure to recognize or respond to worsening symptoms commonly contributes to preventable rehospitalizations. The Discussion (page unavailable) calls for helping patients interpret and respond to symptoms, but the paper does not evaluate whether prioritizing symptom management in clinics reduces readmissions or costs. (LLM, conf=0.83)
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- Authors
- Moser, D. K., Frazier, S. K., Worrall-Carter, L., Biddle, M. J., Chung, M. L., Lee, K. S., & Lennie, T. A.
- Affiliations
- University of Kentucky (US)
- Curtin University, Melbourne, Australia
- Corresponding author
- Moser, Debra K.
- Venue
- European Journal of Cardiovascular Nursing
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06
- Volume
- 10
- Issue
- 2
- Pages
- 124-129
- ISSN
- 1474-5151 (ISSN-L)
- 1873-1953
- PMC
- PMC2987519
- OpenAlex
- W1963711423
- Cited by
- 51
- References
- 34
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 8 · 2012: 3
- FWCI
- 2.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cardiovascular Nursing (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Nursing Research (P20NR010679)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- heart failure, symptom variability, symptom severity, hospital readmission, mortality, event-free survival, dyspnea, edema, symptom monitoring
- MeSH terms
- Aged, Female, Heart Failure, Humans, Longitudinal Studies, Male, Middle Aged, Patient Acceptance of Health Care, Patient Readmission, Risk Factors, Severity of Illness Index, Survival Rate, Disease-Free Survival
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