Heart failure symptom clusters and functional status - a cross-sectional study.

AIM: To identify symptom clusters in individuals with heart failure and evaluate the relationship of the identified clusters to functional status. BACKGROUND: Heart Failure is a global health problem affecting approximately 1-2% of the adult population in developed countries worldwide. Individuals with heart failure may experience as many as nine symptoms and may limit activities that worsen their symptoms or adjust the way they engage in activities. DESIGN: Cross-sectional. METHODS: A convenience sample of individuals (n = 117) with a confirmed diagnosis of heart failure was recruited from an academic medical centre during 2011-2012. Prevalent heart failure symptoms and functional status outcomes (functional limitations and mobility) were evaluated. Factor analysis using the principal components method was used to extract symptom clusters. Regression analysis using a backwards stepwise model-building approach was used to examine the effects of the symptom clusters, age and co-morbidity on functional limitations and mobility. RESULTS: Three symptom clusters, sickness behaviour, discomforts of illness and gastrointestinal distress were extracted. When sickness behaviours and discomforts of illness were both present, functional limitations were more sensitive to sickness behaviours. Sickness behaviour and co-morbidity were related to limited mobility. CONCLUSIONS: Individuals with heart failure may be helped to improve their functional status by managing sickness behaviour and discomforts of illness symptoms. Identification of symptom clusters may lead to the development of interventions focusing on a cluster of heart failure symptoms.

Effect of alertness level and backrest elevation on skin interface pressure.

INTRODUCTION: Critically ill patients may experience reduced mobility and sensation related to various pharmacologic therapies and treatments, making this patient population especially susceptible to pressure ulcers. An alert patient may be better able to reposition in response to discomfort, therefore preventing the development of pressure ulcers. However, little is known about the effect of an individual's alertness level on skin interface pressures. This study describes the effect of alertness level and backrest elevation on skin interface pressures. MATERIALS AND METHODS: Fifty healthy participants were recruited from the Virginia Commonwealth University (Richmond, VA) population. Participants simulated each of 2 alertness levels (sedated or alert) while in 3 backrest elevations (30°, 45°, or 60°). Activity level, backrest elevation, and interface pressures were recorded continuously for 30 seconds. Random effects models were used to examine the effects of alertness level and backrest elevation on average and peak pressure. Participants had a mean age of 30 and 82% were female. RESULTS: There was a significant interaction between alertness level and angle as related to average pressure (P < 0.0001) and peak pressure (P < 0.0001). Increases in backrest elevation increased average pressure and peak pressure. Interface pressures were generally greater when participants were simulating the alert state. CONCLUSION: These findings may indicate that interface pressure is a poor indicator of patient discomfort. Higher body mass index (BMI) was associated with higher average pressure (P < 0.0001), but lower peak pressure (P < 0.0001), suggesting better pressure distribution across the patient's body area. These findings are similar to previous studies in which low BMI is associated with increased pressure ulcer risk. .