Dyadic symptom recognition in heart failure.

Aim: Patients with heart failure experience several symptoms that can be addressed through self-care, which both patients and caregivers in the dyad can contribute to. However, studies on dyadic symptom recognition patterns in heart failure are scarce. We explored whether heart failure patients and their caregivers were concordant or discordant in their symptom recognition behaviors, what characteristics concordant and discordant dyads had, and which variables predicted membership in the concordant or discordant symptom recognition groups.

Methods and results: This is a secondary analysis of an RCT on 500 dyads. Dyads were classified as concordant or discordant according to their response to the symptom recognition item of the Self-Care of Heart Failure Index and the Caregiver Contribution to Self-Care of Heart Failure Index. A multiple logistic regression model was adopted to identify predictors of membership in concordant or discordant dyads. Patients were typically male (58%), retired (77%, n=382), with a median age of 75 years, belonging to NYHA class II (62%); caregivers were typically female (76%), with a median age of 55 years, active workers (47%, n=235), living with the patient (61%), and being patient's child (39%) or spouse (38%). Patient self-care and caregiver contribution to patient self-care were poor (i.e., SCHFI and CC-SCHFI scores <70). Most dyads (87%) showed concordant symptom recognition, meaning that both members agreed on the presence or absence of symptoms. Higher caregiver self-efficacy in contributing to patient self-care predicted membership in the discordant dyadic symptom recognition group. Higher patient symptom burden and cognitive impairment, patient being retired, caregiver preparedness, and caregiver not being the patient's spouse predicted membership in the concordant dyadic symptom recognition group.

Conclusion: Concordant dyadic symptom recognition was predominant and several variables differently predicted the membership to the dyadic symptom recognition groups. This can help to further characterize dyads' attitudes toward symptom recognition, to better understand how to address symptom recognition and awareness of body changes at a patient, caregiver, and dyadic level, and ultimately to allow personalized symptom management strategies.