Clusters of patients with chronic heart failure based on the analysis of body composition parameters and palliative status

The aim of the study : to divide a heterogeneous group of patients with chronic heart failure, taking into account the parameters of body composition and severity of painful symptoms. Object and methods . The study involved 298 patients with CHF. The body composition was assessed: the presence of sarcopenia and obesity (with the calculation of the muscle mass index), functional class, left ventricular ejection fraction, markers galectin-3, hsCRP sodium uretic peptide, Bartel index. A 10-point Edmont scale was used to assess the severity of painful symptoms. A two-stage cluster analysis was performed. Results . Three clusters were identified in the patient structure: the share of the first in the overall structure was 23.2%, the second – 61.1%, the third – 15.8%. It was determined that the first cluster includes patients with sarcopenic obesity. They are characterized by the maximum galectin level and ejection fraction in the sample. They have low walking speed, dynamometry, NТ-proBNP. The intermediate position is occupied by patients of the second cluster (patients with isolated body composition disorder or without it). They are characterized by high walking speed, dynamometry indicators, 6-minute walking test value, Barthel index. Patients of the third cluster are people with low body weight and sarcopenia. They have the maximum Sarcopenia Fast questionnaire level with low walking speed, T6W value, dynamometry indicators and significantly reduced ejection fractions and a high NТ-proBNP level. Patients of the first cluster have the most pronounced pain and fatigue with the lowest level of depression. In patients of the second cluster, pain, fatigue, drowsiness, nausea, shortness of breath, anxiety, and well-being are expressed much less than in patients of the other clusters. And patients of the third group have the highest level of drowsiness, nausea, appetite disorders, shortness of breath, depression, anxiety, and deterioration of well-being. Conclusions . The structure and severity of distressing symptoms varies depending on the cluster and, accordingly, the patient's body composition, which can be used in constructing algorithms for providing palliative care to patients with CHF.