Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure

Debra K. Moser, Susan K. Frazier, Linda Worrall-Carter, Martha J. Biddle, Misook L. Chung, Kyoung Suk Lee, Terry A. Lennie

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background: Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions. Aims: To examine the relationship between patterns of HF symptom variability, and HF event-free survival. Methods: Patients with HF (N = 71) rated HF symptoms daily for 30. days. Symptoms were rated on a 10 point scale anchored at the extreme ends by "worst symptom could be" and "best symptom could be". Patients were followed for an average of 1. year to track HF and cardiac rehospitalizations and all-cause mortality. Results: Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality. Conclusion: Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms.

Original languageEnglish
Pages (from-to)124-129
Number of pages6
JournalEuropean Journal of Cardiovascular Nursing
Issue number2
StatePublished - Jun 2011

Bibliographical note

Funding Information:
This project was partially supported by a Center grant, 1P20NR010679 from the NIH and the National Institute of Nursing Research . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.


  • Heart failure
  • Self-care
  • Symptom recognition

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medical–Surgical
  • Advanced and Specialized Nursing


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