Network Analysis of Symptoms in Patients with Heart Failure: A Scoping Review

Heart failure (HF) is a collection of complex clinical syndromes arising from various etiologies, which lead to abnormal alterations in the structure and/or function of the heart, ultimately resulting in ventricular systolic and/or diastolic dysfunction. This condition represents the advanced stage in the progression of numerous heart diseases . The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates that approximately 56.1 million individuals will be affected by heart failure worldwide in 2023. Of this population, around 14.3 million patients are located in China, representing one quarter or more of the global total . The elevated incidence, mortality, and readmission rates associated with heart failure impose a significant burden on both individual patients and societal medical resources. The intricate pathophysiological mechanisms underlying heart failure often lead patients to experience a range of physical symptoms alongside psychological, social, and behavioral manifestations simultaneously. Numerous studies have established that specific symptoms in heart failure patients share common mechanisms and stable correlations, presenting as distinct symptom clusters. However, traditional approaches to investigating these symptom clusters primarily simplify the relationships among symptoms through dimensionality reduction and classification. Such methods fail to elucidate the interactions between symptoms and do not account for the mechanisms underlying the onset and progression of these symptoms. The emerging research paradigm of symptom networks offers a means to uncover the complex interconnections among various symptoms or symptom clusters. This approach can identify core and bridge symptoms of diseases, thereby assisting healthcare professionals in developing effective symptom management strategies that target critical areas. In recent years, the application of symptom networks in studying heart failure symptoms has increased; however, the evidence remains fragmented and lacks systematic comprehensive analysis. Consequently, this study employs a scope review reporting framework to systematically identify the core symptoms, bridge symptoms, and other characteristics within the symptom network of heart failure patients. It aims to clarify existing deficiencies and gaps in current research, providing an evidence-based foundation for the development of more precise and effective heart failure symptom management strategies.