Dyadic symptom recognition in heart failure

Patients with heart failure experience several symptoms that can be addressed through self-care, which both patients and caregivers in the dyad can contribute to. However, studies on dyadic symptom-recognition patterns in heart failure are scarce. We explored whether heart failure patients and their caregivers were concordant or discordant in their symptom-recognition behaviours, what characteristics concordant and discordant dyads had, and which variables predicted membership in the concordant or discordant symptom-recognition groups.

This is a secondary analysis of a randomized controlled trial (RCT) on 500 dyads. Dyads were classified as concordant or discordant according to their response to the symptom-recognition item of the Self-Care of Heart Failure Index and the Caregiver Contribution to Self-Care of Heart Failure Index. A multiple logistic regression model was adopted to identify predictors of membership in concordant or discordant dyads. Patients were typically male (58%), retired (77%, n = 382), with a median age of 75 years, belonging to New York Heart Association (NYHA) class II (62%); caregivers were typically female (76%), with a median age of 55 years, active workers (47%, n = 235), living with the patient (61%), and being patient's child (39%) or spouse (38%). Patient self-care and caregiver contribution to patient self-care were poor (i.e. SCHFI and CC-SCHFI scores <70). Most dyads (87%) showed concordant symptom recognition, meaning that both members agreed on the presence or absence of symptoms. Higher caregiver self-efficacy in contributing to patient self-care predicted membership in the discordant dyadic symptom-recognition group. Higher patient symptom burden and cognitive impairment, patient being retired, caregiver preparedness, and caregiver not being the patient's spouse predicted membership in the concordant dyadic symptom-recognition group.

Concordant dyadic symptom recognition was predominant and several variables differently predicted the membership to the dyadic symptom-recognition groups. This can help to further characterize dyads' attitudes toward symptom recognition, to better understand how to address symptom recognition and awareness of body changes at a patient, caregiver, and dyadic level, and ultimately to allow personalized symptom management strategies.