Acute Coronary Syndrome Symptom Clusters: Illustration of Results Using Multiple Statistical Methods

Catherine J. Ryan, Karen M. Vuckovic, Lorna Finnegan, Chang G. Park, Lani Zimmerman, Bunny Pozehl, Paula Schulz, Susan Barnason, Holli A. DeVon

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Researchers have employed various methods to identify symptom clusters in cardiovascular conditions, without identifying rationale. Here, we test clustering techniques and outcomes using a data set from patients with acute coronary syndrome. A total of 474 patients who presented to emergency departments in five United States regions were enrolled. Symptoms were assessed within 15 min of presentation using the validated 13-item ACS Symptom Checklist. Three variable-centered approaches resulted in four-factor solutions. Two of three person-centered approaches resulted in three-cluster solutions. K-means cluster analysis revealed a six-cluster solution but was reduced to three clusters following cluster plot analysis. The number of symptoms and patient characteristics varied within clusters. Based on our findings, we recommend using (a) a variable-centered approach if the research is exploratory, (b) a confirmatory factor analysis if there is a hypothesis about symptom clusters, and (c) a person-centered approach if the aim is to cluster symptoms by individual groups.

Original languageEnglish (US)
Pages (from-to)1032-1055
Number of pages24
JournalWestern journal of nursing research
Issue number7
StatePublished - Jul 1 2019


  • acute coronary syndrome
  • cluster analysis
  • latent class analysis
  • symptom clusters
  • symptoms

ASJC Scopus subject areas

  • General Nursing


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