Understanding symptom perception from the psycho-cognitive schemata of patients with heart failure: an exploratory cohort study
Authors: Yu D , Li W C P 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region

Introduction
Symptom perception emerges as an important determinant of effective self-management and health outcomes of heart failure patients. Even various care models were developed to improve symptom perception, the latest systematic review [1] still conclude its uncertain effectiveness. Seeking further understanding on what determine symptom perception is needed to inform intervention development.

Purpose
As an integrative theoretical paradigm [2] suggests that symptom perception is a psychological and cognitive representation of bodily sensation, this exploratory cohort study explored how symptom perception was related to the emotional status, self-care self-efficacy, and disease Knowledge of heart failure patients after adjusting for the priori clinical-demographic profile.

Methods
From Feb 2017 to Aug 2019, 366 heart failure out-patients, who had been diagnosed for at least six months and at NYHA Class II or above, were recruited from the Department of Cardiology of three regional hospitals in Hong Kong. Symptom perception was measured by the corresponding subscale of the Self-Care Heart Failure Index (SCHFI). The psychological and cognitive correlates were measured by the Self-care Self Efficacy Scale, a single-item depression scale and the Dutch Heart Failure knowledge test. Multiple regression analysis was conducted to identify how symptom perception was associated with factors in the psycho-cognitive schemata of heart failure patients after controlling the demographic characteristics, comorbidity and functional status.

Results
The mean age of the sample was 67.0 (SD = 10.7). About 40.0% of them had reduced left ventricular ejection fraction and 75% were in NYHA Class II. The symptom perception was poor, with about 79% of patients had the SCHFI Symptom Perception Scale score lower than the criterion level of 70. About 42-68% of the patients did not adequately attend to the classical symptoms and medication side effects of heart failure. More patients (64%) only paid attention to the non-specific feeling of wellness. Multiple regression analysis indicated that, after controlling the priori confounders, lower depression (β= 0.112, 95%Ci = 0.260 – 2.540, p = 0.016), better self-care self-efficacy (β= 0.463, 95%Ci = 0.345 – 0.513, p&lt;0.001) and higher HF knowledge (β= 0.114, 95%Ci = 0.173 – 1.602, p = 0.015), independently associated with better symptom perception.

Conclusion
This study identifies fair disease-specific symptom perception among patients with heart failure. The results urge for effective care intervention to strengthen this important self-care determinant. In addition to prepare for their cognitive knowledge, strategies to strengthen their self-care self-efficacy and emotional wellness may also play a crucial role for the treatment effectiveness.