Symptom-based clusters in patients with advanced chronic organ failure identify different trajectories of symptom variations.
Aging Clin Exp Res
; 33(2): 419-428, 2021 Feb.
Article
in En
| MEDLINE
| ID: mdl-32951187
ABSTRACT
BACKGROUND:
Healthcare needs are complex and heterogeneous in advanced chronic organ failure. However, based on symptom clusters, groups of patients with similar quality of life, care dependency and life-sustaining treatment preferences can be identified.AIMS:
To evaluate the stability of symptom-based clusters over time, and whether and to what extent the clusters are able to predict patients' 2-year survival and hospitalization rates.METHODS:
This is a secondary analysis of a longitudinal observational study including 95 outpatients with chronic obstructive pulmonary disease (COPD) GOLD stage III-IV, 80 outpatients with chronic heart failure (CHF) NYHA stage III-IV and 80 outpatients with chronic renal failure (CRF) requiring dialysis. Patients were clustered into three groups applying K-means algorithm on baseline symptoms' severity and were then longitudinally evaluated. 2-year survival and hospital admissions during 1 year were estimated using Kaplan-Meier curves and Cox models. 1-year tendencies in symptom variation, using mixed linear models, and clusters comparison over time were performed.RESULTS:
The three clusters were unable to predict patients' survival and hospital admissions. Noteworthy, they show different trajectories of symptom variation, with Cluster 1 patients experiencing a worsening of symptoms, associated with an increased care dependency, and Cluster 2 and Cluster 3 patients being stable or having a relief in some symptoms. Although Cluster 1 is becoming more similar to Cluster 2, the three clusters preserve the overall characteristics and differences.DISCUSSION:
Symptom-based clusters might help to identify patients with different trajectories of symptom variations.CONCLUSION:
Symptom clusters do not predict survival and hospital admissions and are stable over time.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Pulmonary Disease, Chronic Obstructive
/
Heart Failure
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Year:
2021
Type:
Article