TY - JOUR
T1 - Clustering of patients with end-stage chronic diseases by symptoms
T2 - a new approach to identify health needs
AU - Finamore, Panaiotis
AU - Spruit, Martijn A.
AU - Schols, Jos M. G. A.
AU - Incalzi, Raffaele Antonelli
AU - Wouters, Emiel F. M.
AU - Janssen, Daisy J. A.
N1 - Funding Information:
This project was supported by: Proteion Thuis, Horn, The Netherlands; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Netherlands Asthma Foundation [Grant 3.4.06.082], Leusden, The Netherlands; Stichting Wetenschapsbevordering Verpleeghuiszorg (SWBV), Utrecht, The Netherlands. No funding source had any role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Acknowledgements
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2021/2
Y1 - 2021/2
N2 - BackgroundEnd-stage chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) are characterized by a high burden of daily symptoms that, irrespective of the primary organ failure, are widely shared.AimsTo evaluate whether and to which extent symptom-based clusters of patients with end-stage COPD, CHF and CRF associate with patients' health status, mobility, care dependency and life-sustaining treatment preferences.Methods255 outpatients with a diagnosis of advanced COPD (n=95), advanced CHF (n=80) or CRF requiring dialysis (n=80) were visited in their home environment and underwent a multidimensional assessment: clinical characteristics, symptom burden using Visual Analog Scale (VAS), health status questionnaires, timed "Up and Go" test, Care Dependency Scale and willingness to undergo mechanical ventilation or cardiopulmonary resuscitation. Three clusters were obtained applying K-means cluster analysis on symptoms' severity assessed via VAS. Cluster characteristics were compared using non-parametric tests.ResultsCluster 1 patients, with the least symptom burden, had a better quality of life, lower care dependency and were more willing to accept life-sustaining treatments than others. Cluster 2, with a high presence and severity of dyspnea, fatigue, cough, muscle weakness and mood problems, and Cluster 3, with the highest occurrence and severity of symptoms, reported similar care dependency and life-sustaining treatment preferences, while Cluster 3 reported the worst physical health status.DiscussionSymptom-based clusters identify patients with different health needs and might help to develop palliative care programs.ConclusionClustering by symptoms identifies patients with different health status, care dependency and life-sustaining treatment preferences.
AB - BackgroundEnd-stage chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) are characterized by a high burden of daily symptoms that, irrespective of the primary organ failure, are widely shared.AimsTo evaluate whether and to which extent symptom-based clusters of patients with end-stage COPD, CHF and CRF associate with patients' health status, mobility, care dependency and life-sustaining treatment preferences.Methods255 outpatients with a diagnosis of advanced COPD (n=95), advanced CHF (n=80) or CRF requiring dialysis (n=80) were visited in their home environment and underwent a multidimensional assessment: clinical characteristics, symptom burden using Visual Analog Scale (VAS), health status questionnaires, timed "Up and Go" test, Care Dependency Scale and willingness to undergo mechanical ventilation or cardiopulmonary resuscitation. Three clusters were obtained applying K-means cluster analysis on symptoms' severity assessed via VAS. Cluster characteristics were compared using non-parametric tests.ResultsCluster 1 patients, with the least symptom burden, had a better quality of life, lower care dependency and were more willing to accept life-sustaining treatments than others. Cluster 2, with a high presence and severity of dyspnea, fatigue, cough, muscle weakness and mood problems, and Cluster 3, with the highest occurrence and severity of symptoms, reported similar care dependency and life-sustaining treatment preferences, while Cluster 3 reported the worst physical health status.DiscussionSymptom-based clusters identify patients with different health needs and might help to develop palliative care programs.ConclusionClustering by symptoms identifies patients with different health status, care dependency and life-sustaining treatment preferences.
KW - Chronic obstructive pulmonary disease
KW - Congestive heart failure
KW - Chronic renal failure
KW - Symptoms
KW - Cluster analysis
KW - QUALITY-OF-LIFE
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - CHRONIC ORGAN FAILURE
KW - HEART-FAILURE
KW - PALLIATIVE CARE
KW - ADVANCED CANCER
KW - OLDER PERSONS
KW - RENAL-DISEASE
KW - CO-MORBIDITY
KW - GO TEST
U2 - 10.1007/s40520-020-01549-5
DO - 10.1007/s40520-020-01549-5
M3 - Article
C2 - 32279242
SN - 1594-0667
VL - 33
SP - 407
EP - 417
JO - Aging Clinical and Experimental Research
JF - Aging Clinical and Experimental Research
IS - 2
ER -