Relationships Among Symptom Burden, Self‐Care, and Quality of Life Among Individuals Living With Heart Failure and Multimorbidity: A Cross‐Sectional Study

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Abstract
Aim: To examine factors, including symptom burden profiles and self‐care, associated with quality of life among individuals with heart failure and multimorbidity. Design: A cross‐sectional design. Methods: 353 adults aged 50 years or older with heart failure and at least one additional chronic condition were recruited from a university‐affiliated hospital. Three symptom burden groups were identified (low, moderate, and high) through latent profile analysis of the Edmonton Symptom Assessment Scale scores. The Heart Failure Self‐care Index and EuroQoL‐5D‐5L measured self‐care behaviours and quality of life. This study examined group differences and associations overall and stratified by symptom burden groups via multivariable linear regression. Results: A higher disease burden and the high symptom burden group compared to the low symptom burden group were associated with lower quality of life. Self‐care maintenance was positively associated with a higher quality of life, but not in the high‐burden group. Among individual symptoms, pain and depression were associated with lower quality of life. In the high‐burden group, older age was positively associated with quality of life. Higher symptom burden groups included a greater proportion of women and middle‐aged adults. Conclusion: Symptom burden and self‐care maintenance show significant associations with quality of life in multimorbidity. Symptom burden profiles identified through latent profile analysis may complement conventional approaches by targeting high‐risk individuals, such as middle‐aged individuals and women with high symptom burden, for follow‐up and integrated multimorbidity management. Impact: For healthcare providers, including nurses, these findings underscore the importance of holistic, symptom‐based care approaches combined with routine support for self‐care maintenance. Adopting a life‐course approach, through early identification and management of high‐risk individuals, may help promote aging in place with a better quality of life for those with heart failure and multimorbidity. Reporting Method: STROBE checklist. Patient or Public Contribution: No patient or public contribution.

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