Unveiling the Configuration of Symptom Burden in Older Adults With Heart Failure: A Fuzzy‐Set Qualitative Comparative Analysis for Enhanced Healthcare Solutions

BACKGROUND: While previous studies have examined the impact of individual factors on symptom burden among older adults with heart failure (HF), the potential pathways resulting from factor configurations remain unclear. AIMS: This study aims to investigate the diverse pathways of symptom burden in older adults with HF. METHODS: This survey was conducted from January to May 2024 in Tianjin, China, involving older adults with HF. Symptom burden and its associated physiological (age and age-adjusted Charlson Comorbidity Index), psychological (anxiety and depression) and environmental factors (social support and per capita monthly income) were evaluated based on the theory of unpleasant symptoms. Fuzzy-set qualitative comparative analysis (fsQCA) was employed for data analysis. RESULTS: We included 310 participants. No single factor was a necessary condition for symptom burden, with consistency coefficients below 0.90. Through various factor configurations, six distinct pathways were identified. For example, in Pathway 1, a configuration of high depression and low household income contributed to high symptom burden. These six pathways explained 25.1%-65.3% of high symptom burden. CONCLUSIONS: In clinical nursing practice, nurses should assess the symptom burden of older adults with HF by considering a variety of factors and their potential configurations and then develop personalized, multifactorial interventions to alleviate it.