Exploring symptom clusters and core symptoms during the vulnerable phase in patients with chronic heart failure: a network-based analysis

Aims: To construct a symptom network of chronic heart failure patients in the vulnerable period and identify core symptoms and bridge symptoms between different symptom clusters.

Methods and results: A convenience sampling method was used to select 402 patients with chronic heart failure within 3 months after discharge from the cardiology departments of two tertiary-level A hospitals in Zhenjiang City, and symptom-related entries of the Minnesota living with heart failure questionnaire (MLHFQ) were used to conduct the survey. Symptom networks were constructed using the R language. The constructed symptom network was structurally stable, and the correlation stability coefficient was 0.595. In the network, 'depression' (MLHFQ9), 'dyspnoea on exertion' (MLHFQ3), and 'worry' (MLHFQ7) are the core symptoms. 'Cognitive problems' (MLHFQ8), 'sleep difficulties' (MLHFQ4), and 'fatigue' (MLHFQ6) are bridge symptoms connecting the emotional-cognitive and somatic symptom clusters. In the network comparison test, there were no significant differences in symptom networks between patients of different genders and places of residence.

Conclusion: 'Depression' and 'increased need to rest' are the core and most severe symptoms, respectively, in the vulnerable phase of chronic heart failure, and 'cognitive problems' is the most important bridge symptom. Clinical caregivers can build a precise intervention programme based on the core and bridge symptoms and focus on the emotional and cognitive symptom clusters, in order to improve the efficacy of symptom management during the vulnerable period in patients with chronic heart failure.