Abstract:

Objective To identify the symptom clusters and warning symptoms in patients with acute decompensated heart failure（ADHF），and to analyze the correlation between the severity of warning symptoms and cardiac function and blood biochemical indexes. Methods From September 2023 to September 2024，268 ADHF patients hospitalized in the cardiology wards of a tertiary Grade A hospital in Hangzhou were selected by convenience sampling. The general information questionnaire and the revised Memory Symptom Assessment Scale were used to conduct a questionnaire survey，and the related indexes of cardiac function and blood biochemistry of patients were collected after admission. The symptom clusters were extracted by principal component analysis，and the warning symptoms of the symptom cluster were determined based on the results of the Apriori algorithm. Correlation analysis was used to explore the relationship between warning symptoms and cardiac function and blood biochemistry. Results There were four symptom clusters in ADHF patients，including the fluid retention symptom cluster，the respiratory fatigue symptom cluster，the emotional and psychological symptom cluster，and the digestive and metabolic symptom cluster. Each symptom cluster corresponds to a specific warning symptom：leg or arm edema，dyspnea when lying flat，a sense of sadness，and dry mouth. The serum type B natriuretic peptide（BNP） level was positively correlated with the severity of leg or arm edema（r=0.223，P=0.033）. The serum BNP level was positively correlated with the severity of dyspnea when lying flat（r=0.201，P=0.020）. The cardiac function classification was positively correlated with the severity of sadness（r=0.360，P=0.001） and dry mouth（r=0.238，P=0.004）. Serum potassium was negatively correlated with the severity of dyspnea when lying flat（r=-0.249，P=0.004），and left ventricular ejection fraction（LVEF） was negatively correlated with leg or arm edema（r=-0.171，P=0.018）. Conclusion Warning symptoms exist in four symptom clusters among ADHF patients. The severity of warning symptoms is related to cardiac function classification，LVEF，serum potassium and serum BNP. It serves as a precise foundation for clinical nursing personnel to detect early changes in patients’ clinical status and develop individualized symptom management strategies.

Key words: Heart Failure, Acute Decompensation, Symptom Cluster, Warning Symptom, Nursing