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Relationships Among Symptom Burden, Self-Care, and Quality of Life Among Individuals Living With Heart Failure and

Soo Hyun Kim¹, Arum Lim¹, Chitchanok Benjasirisan¹

¹Johns Hopkins School of Nursing, Baltimore, Maryland, USA.

Journal of Clinical Nursing

|February 25, 2026

Abstract

Aim:

To examine factors, including symptom burden profiles and self-care, associated with quality of life among individuals with heart failure and multimorbidity.

Design:

A cross-sectional design.

Methods:

353 adults aged 50 years or older with heart failure and at least one additional chronic condition were recruited from a university-affiliated hospital. Three symptom burden groups were identified (low, moderate, and high) through latent profile analysis of the Edmonton Symptom Assessment Scale scores. The Heart Failure Self-care Index and EuroQoL-5D-5L measured self-care behaviours and quality of life. This study examined group differences and associations overall and stratified by symptom burden groups via multivariable linear regression.

Results:

A higher disease burden and the high symptom burden group compared to the low symptom burden group were associated with lower quality of life. Self-care maintenance was positively associated with a higher quality of life, but not in the high-burden group. Among individual symptoms, pain and depression were associated with lower quality of life. In the high-burden group, older age was positively associated with quality of life. Higher symptom burden groups included a greater proportion of women and middle-aged adults.

Conclusion:

Symptom burden and self-care maintenance show significant associations with quality of life in multimorbidity. Symptom burden profiles identified through latent profile analysis may complement conventional approaches by targeting high-risk individuals, such as middle-aged individuals and women with high symptom burden, for follow-up and integrated multimorbidity management.

Impact:

For healthcare providers, including nurses, these findings underscore the importance of holistic, symptom-based care approaches combined with routine support for self-care maintenance. Adopting a life-course approach, through early identification and management of high-risk individuals, may help promote aging in place with a better quality of life for those with heart failure and multimorbidity.

Reporting Method:

STROBE checklist.

Patient Or Public Contribution:

No patient or public contribution.

Keywords:

heart failure multimorbidity quality of life symptom burden

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