Cross-classification of physical and affective symptom clusters and 180-day event-free survival in moderate to advanced heart failure

Background: The relationship between physical and affective symptom clusters in heart failure (HF) is unclear. Objectives: To identify associations between physical and affective symptom clusters in HF and to quantify outcomes and determinants of symptom subgroups. Methods: This was a secondary analysis of data from two cohort studies among adults with HF. Physical and affective symptom clusters were compared using cross-classification modeling. Cox proportional hazards modeling and multinomial logistic regression were used to identify outcomes and determinants of symptom subgroups, respectively. Results: In this young, mostly male sample (n = 274), physical and affective symptom clusters were cross-classified in a model with acceptable fit. Three symptom subgroups were identified: congruent-mild (69.3%), incongruent (13.9%), and congruent-severe (16.8%). Compared to the congruent-mild symptom group, the incongruent symptom group had significantly worse 180-day event-free survival. Conclusion: Congruence between physical and affective symptom clusters should be considered when identifying patients at higher risk for poor outcomes.