Abstract: Objective: To identify symptom clusters in elderly patients with chronic heart failure, explore the relationships among symptoms within these clusters, and identify the bridge symptoms. Methods: Convenience sampling was employed to select 252 elderly patients with chronic heart failure from two hospitals in Wenzhou. A questionnaire survey was conducted using the Memorial Symptom Assessment Scale-Heart Failure. Symptom clusters were identified through exploratory factor analysis, and network analysis was used to identify the bridge symptoms among these clusters. Results: We identified 4 symptom clusters: respiratory sleep disorder, peripheral edema, dizziness and fatigue, and oropharyngeal discomfort. The top four bridge symptoms were swelling in the legs or arms (rS=0.559, rE=3.756), difficulty breathing when lying flat (rS=0.408, rE=4.556), loss of appetite (rS=0.396, rE=3.999), and dry mouth (rS=0.363, rE=2.199). The symptom expected to have the greatest impact was waking up with shortness of breath at night (rE=4.750, rS=0.202). Conclusion: Swelling in the legs or arms serves as the core bridge symptom in elderly patients with chronic heart failure. Waking up with shortness of breath at night, difficulty breathing when lying flat, loss of appetite, and dry mouth act as bridge symptoms connecting symptom clusters. Targeted interventions for these bridge symptoms, based on their bridging roles among different symptom clusters, have the potential to enhance the effectiveness of symptom management to a certain degree.

Key words: aged; chronic heart failure; symptom cluster; bridge symptom; network analysis