| Summary: | Patients with heart failure are at high risk for multiple admissions for exacerbations of their illness. Research supports that delay in symptom recognition contributes to the high readmission rate. Efforts to decrease these admissions have had varying results utilizing primarily an educational model of treatment. The lack of consistent results suggests there are other factors, which affect a patient's awareness of, and recognition of the significance of their symptoms. The purpose of this study was to explore factors affecting symptom awareness and recognition on delay in care-seeking in patients with acute heart failure. The specific aim was to explore the relationship between somatic awareness, uncertainty, symptom pattern, age, gender, and heart failure history on delay in this population. The Heart Failure Somatic Awareness Scale (HFSAS), the Modified Somatic Perception Questionnaire (MSPQ), and the Mishel Uncertainty in Illness, community form (MUIS-C) were administered to assess general and heart failure specific somatic awareness and level of uncertainty in 201 patients with acute heart failure. A semi-structured interview was conducted to collect demographic data and to quantify duration of heart failure symptoms prior to care-seeking. Clinical data was collected from patient interviews and the medical record. Patients had a highly variable response to distressing symptoms of heart failure. The median duration of dyspnea was 4 days while dyspnea on exertion (DOE) had a longer median duration of 7 days. Acute symptoms such as chest pain, acute dyspnea, and paroxysmal nocturnal dyspnea (PND) had a median duration of 5.25 hours with a range up to one week. Males had a significantly longer duration of PND when compared to females, however there were no significant gender differences in perceived severity of symptoms. HFSAS and acute symptom onset were significant predictors of symptom duration. Age was negatively correlated with symptom duration. Previous admission for heart failure and level of uncertainty were not significant predictors of symptom duration. Patients had high levels of uncertainty despite medical stabilization and alleviation of symptoms.
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