Longitudinal Transition of Symptom Cluster Profiles Among Community-Dwelling Older Adults With Heart Failure

Older adults with heart failure experience clustered symptoms. However, little is known about how symptom clusters transition over time.

This study aimed to (a) identify the longitudinal transition of symptom cluster profiles over 8 years and (b) examine the associations between demographic and clinical factors and the transition between symptom cluster profiles over time.

We conducted a longitudinal secondary analysis of data from the Health and Retirement Study's 2008, 2012, and 2016 surveys. We included participants with heart failure in the core data sets and their proxy respondents in the exit data sets. We included demographic and clinical variables as well as six symptoms (fatigue, shortness of breath, pain, swelling, depressive symptoms, dizziness) through physical health interviews. We used latent transition analysis and multinominal regressions to determine longitudinal profiles and explored the association between demographic and clinical factors and membership in symptom cluster profiles.

Among 690 participants, we found four symptom cluster profiles (high burden, low burden, distressing, and respiratory-depressive distress). Participants in the low burden at baseline had the highest probability of transitioning to the respiratory-depressive distress profile. Participants in the respiratory-depressive distress at 4 years had the highest probability of transitioning to the high burden profile. Male sex, Black/African American race, smoking, and comorbidities were associated with the increased odds of transiting from the low symptom burden to the high symptom burden profile.

Symptom cluster profile memberships were stable over an 8-year period. However, symptom cluster profiles are changeable and deteriorate over time. Identifying predictive factors enables targeted interventions for those at highest risk.