Abstract
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.
Original language | English |
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Pages (from-to) | 407-417 |
Number of pages | 11 |
Journal | Aging Clinical and Experimental Research |
Volume | 33 |
Issue number | 2 |
Early online date | 11 Apr 2020 |
DOIs | |
Publication status | Published - Feb 2021 |
Keywords
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Chronic renal failure
- Symptoms
- Cluster analysis
- QUALITY-OF-LIFE
- OBSTRUCTIVE PULMONARY-DISEASE
- CHRONIC ORGAN FAILURE
- HEART-FAILURE
- PALLIATIVE CARE
- ADVANCED CANCER
- OLDER PERSONS
- RENAL-DISEASE
- CO-MORBIDITY
- GO TEST