Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis

Bridging the gap between recommendation and reality: Improving dietary adherence of heart failure populations a cross-sectional study in Ethiopia

BACKGROUND

Heart failure (HF), a complex condition arising from impaired ventricular function, necessitates strict adherence to dietary recommendations for optimal patient management. However, information regarding adherence and its influencing factors remains limited.

AIM

This study aimed to assess dietary recommendation adherence and its associated factors among HF patients at Southern Ethiopia public hospitals.

METHODS AND RESULTS

A cross-sectional study involving 521 participants employed systematic random sampling. Data collection utilized pre-tested, interviewer-administered questionnaires and medical chart reviews. Data were entered and analyzed using Epi Data 3.1 and SPSS 20.0 software. Descriptive statistics were performed. Variables with p-values < 0.25 in binary logistic regression were included in multivariable logistic regression analyses. Statistical significance was set at p < 0.05 with a 95% confidence interval. Results are presented in text, tables, and figures. With a 97.4% response rate, adherence ranged from 20.3% (vegetables and fruits) to 60.3% (fat-free diet). Only 8.1% achieved good adherence across all parameters, with overall adherence at 33.4% (95% CI: 29-37). Multivariable analysis revealed that patients aged 41-60 years (AOR: 1.7), with a history of admission (AOR: 2.5), free from comorbidities (AOR: 0.58), and possessing a favorable attitude (AOR: 0.45) had statistically significant associations with good adherence.

CONCLUSION

Dietary adherence among HF patients remains a challenge. Healthcare providers, particularly those in chronic follow-up settings, should prioritize improving patient attitudes towards proper dietary practices. Tailored education programs targeting younger patients and those free from comorbidities should be implemented. Continuous monitoring, evaluation, and staff recognition for effective client counseling are crucial.

Self-care in patients affected by inflammatory bowel disease and caregiver contribution to self-care (IBD-SELF): a protocol for a longitudinal observational study

INTRODUCTION

Supporting patient self-care and the contribution of their caregivers is crucial in chronic illness care. Inflammatory bowel disease (IBD) is a chronic condition whose prevalence is expected to double, especially in Western countries. IBD symptoms can negatively impact patients' well-being, causing high anxiety, depression, stress and reduced quality of life. These symptoms also affect the health of family members and friends, who often take on caregiving roles during exacerbations. Knowledge about self-care in IBD (IBD-SELF) is limited, and few studies have explored this context. This paper outlines a research protocol for a multicentre longitudinal study to investigate patient self-care and caregiver contributions to IBD-SELF.

METHODS AND ANALYSIS

A sample of 250 consecutive patients diagnosed with IBD and their caregivers will be recruited from 9 dedicated IBD units in northern, central and southern Italy during outpatient visits. Data collection will occur at baseline, 6 and 12 months after enrolment. Multivariable regressions, path analyses and structural equation models will identify predictors (eg, health literacy, caregiver burden and depression) and outcomes (use of healthcare services, disease severity and quality of life) of self-care and caregiver contributions. Dyadic analyses will control for the interdependence of dyad members.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Territorial Ethics Committee (Lazio 3) N. 0023486/23 and registered on ClinicalTrials.gov (Identifier number: NCT06015789). This study will enhance our understanding of the self-care process in the patient-caregiver dyad in IBD, aiding the design of future educational interventions and promoting greater patient and caregiver involvement in the care pathway.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT06015789.

Contribution of informal caregivers to self-care in individuals with heart failure

OBJECTIVES

to evaluate the contribution of informal caregivers to the self-care of individuals with heart failure.

METHODS

a cross-sectional study was conducted with 87 caregivers from March to October 2022 in the city of João Pessoa/PB. The caregivers' contribution was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index instrument. Scores ≥ 70 points indicate adequate contribution. Data were analyzed using descriptive statistics and Spearman's correlation.

RESULTS

the sample consisted of 81.6% female caregivers. Median scores obtained for the self-care contribution scales were: 63.3 for maintenance; 55.5 for management; and 66.6 for confidence. Caregivers never or rarely recommended monitoring body weight, regular physical exercise, extra use of diuretics, and fluid restriction.

CONCLUSIONS

informal caregivers showed inadequate contribution in the areas of maintenance, management, and confidence in self-care of individuals with heart failure.

Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial

BACKGROUND

Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs.

METHODS

Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments.

RESULTS

In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes.

CONCLUSIONS

These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.

Self-care behavior and associated factors among adult heart failure patients in outpatient cardiac follow-up unit at Wachemo University Nigist Eleni Comprehensive Specialized Hospital, Southern Ethiopia

BACKGROUND

Heart failure is a serious medical condition that occurs when the heart is unable to pump sufficient blood to meet the needs of the tissues. Good self-care is an essential behavior in long term management and maintenance of physiologic stability, better medical and person-centered outcomes. Poor self-care behavior deteriorates the outcomes of heart failure patients. However, there were no sufficient evidences that illustrate the topic in the country, including the study area.

METHODOLOGY

Institutional based cross-sectional study was conducted among 250 heart failure patients from July 5-August 4, 2021. All adult heart failure patients who fulfill the inclusion criteria and have appointment during study period were included in the study. Interview and medical chart review was used to collect data. Epidata version 3.1 and SPSS version 20 were used for data entry and analysis respectively. Bivariate and multivariable analysis was computed. The model fitness was checked by Hosmer and Lemeshow test.

RESULTS

From the total patients, 240 were interviewed with the response rate of 96%. Among these, 140(58.3%) [95% CI: 52.6, 64.9] had poor self-care behavior. Age>54: 9.891 [2.228, 43.922], poor knowledge: 6.980[1.065, 45.727], depression: 4.973[1.107, 22.338], low social support: 6.060[1.373, 26.739], insomnia: 4.801[1.019, 22.622] and duration with heart failure <1 year: 5.782[1.438, 23.247] were factors associated with poor self-care behavior.

CONCLUSION

In this study, more than half of participants attending at Wachemo University Nigist Eleni Comprehensive Specialized Hospital in outpatient cardiac follow-up unit had poor self-care behavior. Of the study variables, older age, poor knowledge, depressive symptoms, low social support, insomnia and short duration with heart failure were related with poor self-care behavior. Thus, the findings highlight importance of assessing level of self-care behavior and implicate direction to take action to enhance level of self-care behavior.

Telehealth care and remote monitoring strategies in heart failure patients: A systematic review and meta-analysis

BACKGROUND

Heart failure (HF) is a cardiac clinical syndrome that involves complex pathological aetiologies. It represents a growing public health issue and affects a significant number of people worldwide.

OBJECTIVES

To synthesize evidence related to the impact of telemonitoring strategies on mortality and hospital readmissions of heart failure patients.

METHODS

A systematic literature review was conducted using PubMed, Scopus, CINAHL, IEEE Xplore Digital Library, Engineering Source, and INSPEC. To be included, studies had to be in English or Italian and involve heart failure patients of any NYHA class, receiving care through any telecare, remote monitoring, telemonitoring, or telehealth programmes. Articles had to contain data on both mortality and number of patients who underwent rehospitalizations during follow-ups. To explore the effectiveness of telemonitoring strategies in reducing both one-year all-cause mortality and one-year rehospitalizations, studies were synthesized through meta-analyses, while those excluded from meta-analyses were summarized narratively.

RESULTS

Sixty-one studies were included in the review. Narrative synthesis of data suggests a trend towards a reduction in deaths among monitored patients, but the number of rehospitalized patients was higher in this group. Meta-analysis of studies reporting one-year all-cause mortality outlined the protective power of care models based on telemonitoring in reducing one-year all-cause mortality. Meta-analysis of studies reporting the number of rehospitalized patients in one-year outlined that telemonitoring is effective in reducing the number of rehospitalized patients when compared with usual care strategies.

CONCLUSION

Evidence from this review confirms the benefits of telemonitoring in reducing mortality and rehospitalizations of HF patients. Further research is needed to reduce the heterogeneity of the studies.

Individual and systems-related factors associated with heart failure self-care: a systematic review

BACKGROUND

Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 - Dec 2021) using the Socioecological Model as a review framework.

METHODS

An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review.

RESULTS

A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level.

CONCLUSION

Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.

Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study

BACKGROUND

Promoting patients' sense of security is among the goals of nursing care within heart failure management.

OBJECTIVE

The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure.

METHODS

Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status.

RESULTS

The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status.

CONCLUSIONS

Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.

Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining

Objectives

To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age.

Methods

A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes.

Results

A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years.

Conclusion

The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.

Psychometric properties of the self-care of chronic illness inventory in Chinese older adults with multiple chronic conditions

BACKGROUND

Existing self-care measures for the Chinese population are specific to single chronic conditions. No generic self-care measures exist for the Chinese population with multiple chronic conditions.

OBJECTIVES

To test the structural validity, concurrent validity and reliability of the Self-care of Chronic Illness Inventory (SC-CII) in Chinese older adults with multiple chronic conditions.

METHODS

This cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. A diverse sample of Chinese older adults with multiple chronic conditions (n = 240) was recruited. Structural validity was assessed with confirmatory factor analysis. Concurrent validity was investigated with hypotheses testing of the relationships between perceived stress, resilience and self-care. Reliability was assessed with Cronbach's alpha and McDonald's omega. Finally, a simultaneous confirmatory factor analysis was conducted to test the general model with all items and all three subscales.

RESULTS

Confirmatory factor analysis supported the two-factor structure of the self-care maintenance and self-care management subscales and the one-factor structure of the self-care monitoring subscale. Concurrent validity was supported by the significant negative correlation (r ranged from -0.18 to -0.38, p < .01) with perceived stress and the significant positive correlation (r ranged from 0.31 to 0.47, p < .01) with resilience. Reliability estimates ranged from 0.77 to 0.82 across the three subscales. The simultaneous confirmatory factor analysis did not support the more general model with the combined set of items.

CONCLUSION

The SC-CII is valid and reliable for Chinese older adults with multiple chronic conditions. Future cross-cultural assessment should be conducted to investigate the measurement equivalence of the SC-CII in individuals from Western and Eastern cultural groups.

IMPLICATIONS FOR PRACTICE

With the increasing number of older adults in China who are living with multiple chronic conditions and the call for culturally tailored self-care interventions, this self-care measure can be used in geriatric primary care settings, long-term facilities and homes to improve the understanding and practice of self-care in older Chinese adults.

Association Between Self-care and Resilience: A Cross-sectional Study in Heart Failure Patients

BACKGROUND

Self-care (SC) is a cornerstone in heart failure management and is related to patient outcomes. The continuous and complex demands of SC can be experienced as stressful and may require patients to apply resilient behaviors as they manage their conditions. Resilience may be a helpful factor in performing SC.

OBJECTIVE

The aim of this study was to determine the association between resilience and SC in patients with heart failure.

METHODS

A cross-sectional study was performed between January 2020 and January 2021. Participants were asked to complete a questionnaire addressing baseline characteristics, the 2-item Patient Health Questionnaire, the Resilience Evaluation Scale, and the Self-Care of Chronic Illness Inventory, which measures 3 concepts of SC: SC maintenance, SC monitoring, and SC management. Multiple regression analysis was performed to determine whether resilience was associated with SC.

RESULTS

Eighty-six patients were included, and 74 patients completed the questionnaire. In the univariate analysis, an association was found between resilience and SC maintenance, resulting in an increase in SC for patients with higher resilience (β = 0.24; 95% confidence interval, 0.03-0.96). In the multivariate analysis adjusted and corrected for confounders, no significant associations between resilience and all SC scales were found.

CONCLUSION

This study could not demonstrate significant associations between resilience and all SC scales. This study contributes to the body of knowledge on factors that can mediate or moderate SC. Further longitudinal research should be performed to study cause-effect relationships.

Patient’s knowledge, gender, and physical activity level as the predictors of self-care in heart failure patients

Introduction: Self-care management is the fundamental approach for Heart Failure (HF) management and is influenced by patient ability in preventing rehospitalization, mortality, and morbidity. Therefore, this study aims to investigate the predictors of a patient’s ability in HF self-care management. Design and Methods: A cross-sectional study was carried out on 96 patients with HF. The data were collected through interviews using questionnaires on demographic characteristics, physical activity (IPAQ), knowledge (Dutch Heart Failure Knowledge Score), and self-care management (Self Care Heart Failure Index). Subsequently, the data were analyzed using logistic regression analysis, and the best fit model for predicting self-care management in HF patients was generated. Results: The proportion of samples was 56.3% female, with mostly primary school (50%) as their education level. Furthermore, the proportion of patients with adequate HF self-care management was only 21% of the total participant. Based on the results, the patient’s physical activity level, HF knowledge, and gender were verified as a predictor of self-care management. Conclusions: The HF knowledge level, physical activity level, and gender were the predictors of HF self-care management.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model

AIM

The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge.

DESIGN

Correlational design based on cross-sectional data from a multicentre survey study.

METHODS

People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling.

RESULTS

In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90.

CONCLUSION

Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care.

IMPACT

This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes.

PATIENT OR PUBLIC CONTRIBUTION

People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Development and validation of a mobile application for heart failure patients self-care

OBJECTIVE

To develop and verify content and face validity evidence of a mobile application prototype for heart failure patients self-care.

METHOD

Study of technological development based on Contextualized Instructional Design. In the validation stage, six cardiology specialist nurses evaluated the content through the Suitability Assessment of Materials and 13 people with heart failure underwent face validity assessment, through content validity index. Data were analyzed using descriptive statistics.

RESULTS

The prototype of the application, called "Tum Tum", has an interface and free navigation screens covering the concept of heart failure, its causes, symptoms and signs, diagnosis, and treatment. It has a mosaic with educational guidelines, resources for early recognition of signs of clinical decompensation, registration for body weight control, reminders for medication use, consultation and exam schedule. The technology proved to be adequate among specialists and the target audience.

CONCLUSION

It was possible to develop and validate the content and face of the "Tum Tum" application prototype, which demonstrates the potential to promote self-care in people with heart failure.

Structural Relationships Between Cognitive Function, Depressive Symptoms, Self-Care Confidence, and Maintenance in Patients With Heart Failure

Introduction

In order to promote self-care maintenance behavior in patients with heart failure (HF), it is necessary to identify the direct and indirect effects of major latent variables.

Objective

This study aimed to identify structural relationships between different domains of cognitive function, depression and self-care confidence, and self-care maintenance.

Methods

This descriptive study involved a secondary analysis using data of 201 patients with HF from two observational studies in three hospitals in Korea. The structural equation model using AMOS version 24.0 was constructed to assess the relationships among the variables. The Seoul Neuropsychological Screening Battery was used to assess global cognition, immediate/delayed memory, and executive function, and the Self-Care of HF Index v.6.2. was used for self-care confidence and maintenance.

Results

Self-care maintenance was affected by memory function with a significant direct effect (β=.43, p = .006), as well as self-care confidence (β=.70, p < .001). Memory function and global function indirectly affected self-care maintenance through self-care confidence (β = -.37, p = .002; β = .14, p = .030). Depressive symptoms also had an indirect effect through self-care confidence on self-care maintenance (β = -.21, p = .005).

Conclusion

This study confirmed that it is important to increase self-care confidence through supportive care and to maintain memory function for maintaining self-care in the chronic course of HF patients. In particular, this study suggests that it is necessary to perform periodic memory check-ups for chronic HF patients on an outpatient basis, and counseling and education are needed to improve memory and increase confidence in self-care.

Self-Care and Quality of Life Among Adult Patients With Heart Failure: Scoping Review

Introduction

Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF.

Methods

Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included.

Results

Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF.

Conclusion

Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.

Time to Revisit Heart Failure Self-Care: A Concept Analysis

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self .

The Effect of an Educational Intervention on Self-Care in Patients with Venous Leg Ulcers-A Randomized Controlled Trial

Background: Although patients with venous leg ulcers are involved in ulcer management, little is known about why and how these patients self-treat their ulcers without direct supervision by health professionals. Yet patients’ knowledge of ulcer management can be important for achieving ulcer closure and/or preventing recurrence. This study thus investigates the effects of an educational intervention on knowledge of self-care among patients with venous leg ulcers, mainly on wound dressing practice, compression therapy, physical activity and nutrition. Methods and participants: This research was conducted in three outpatient hospitals in central Croatia. An educational brochure was made and distributed to patients; patients were surveyed about caring for venous leg ulcers before the brochure was distributed and after 3 months. Results: In total, 208 patients were involved in the study: 112 in the experimental group and 96 in the control group. The educational intervention increased awareness of compression therapy, knowledge of recurrence prevention, appropriate lifestyle habits, and warning signs related to venous leg ulcers. Conclusions: Patient education on illness and self-care is necessary to achieve positive effects in self-care knowledge. In this study, patients learned how to change dressings, learned how to improve their lifestyle, and were empowered to deal with their illness.

Desenvolvimento e validação de aplicativo móvel para o autocuidado de pessoas com insuficiência cardíaca

RESUMO Objetivo: Desenvolver e verificar as evidências de validade de conteúdo e face de um protótipo de aplicativo móvel para o autocuidado de pessoas com insuficiência cardíaca. Método: Estudo de desenvolvimento tecnológico baseado no Design Instrucional Contextualizado. Na etapa de validação, seis enfermeiros especialistas em cardiologia avaliaram o conteúdo por meio do Suitability Assessment of Materials e 13 pessoas com insuficiência cardíaca realizaram avaliação de face, pelo índice de validade de conteúdo. Os dados foram analisados por meio de estatística descritiva. Resultados: O protótipo do aplicativo, nomeado “Tum Tum”, possui interface e telas de livre navegação que abordam o conceito da insuficiência cardíaca, causas, sinais e sintomas, diagnóstico e tratamento. Apresenta mosaico com orientações educativas, recursos para o reconhecimento precoce de sinais de descompensação clínica, registro para controle do peso corporal, lembretes para o uso de medicamentos, agenda de consultas e exames. A tecnologia mostrou-se adequada entre especialistas e público-alvo. Conclusão: Foi possível desenvolver e validar o conteúdo e face do protótipo do aplicativo “Tum Tum”, que demonstra potencial para promover o autocuidado em pessoas com insuficiência cardíaca.

Evolution of self-care in patients with heart failure at the first outpatient return and three months after hospital discharge

OBJECTIVE

to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1).

METHOD

an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student's t test and paired distribution (McNemar) with a significance level of 0.05.

RESULTS

we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales.

CONCLUSION

self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.

The influence of gender and race on heart failure self-care

OBJECTIVES

To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care.

METHODS

A secondary analysis of baseline data (n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence.

RESULTS

Univariate analyses indicated that Caucasians reported significantly better self-care maintenance (p = 0.042), while non-Caucasians reported significantly better self-care management (p = 0.003). Males had significantly higher self-care confidence scores versus women (p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (β = -11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (β = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance.

DISCUSSION

Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.

Machine learning for subtype definition and risk prediction in heart failure, acute coronary syndromes and atrial fibrillation: systematic review of validity and clinical utility

BACKGROUND

Machine learning (ML) is increasingly used in research for subtype definition and risk prediction, particularly in cardiovascular diseases. No existing ML models are routinely used for cardiovascular disease management, and their phase of clinical utility is unknown, partly due to a lack of clear criteria. We evaluated ML for subtype definition and risk prediction in heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation (AF).

METHODS

For ML studies of subtype definition and risk prediction, we conducted a systematic review in HF, ACS and AF, using PubMed, MEDLINE and Web of Science from January 2000 until December 2019. By adapting published criteria for diagnostic and prognostic studies, we developed a seven-domain, ML-specific checklist.

RESULTS

Of 5918 studies identified, 97 were included. Across studies for subtype definition (n = 40) and risk prediction (n = 57), there was variation in data source, population size (median 606 and median 6769), clinical setting (outpatient, inpatient, different departments), number of covariates (median 19 and median 48) and ML methods. All studies were single disease, most were North American (n = 61/97) and only 14 studies combined definition and risk prediction. Subtype definition and risk prediction studies respectively had limitations in development (e.g. 15.0% and 78.9% of studies related to patient benefit; 15.0% and 15.8% had low patient selection bias), validation (12.5% and 5.3% externally validated) and impact (32.5% and 91.2% improved outcome prediction; no effectiveness or cost-effectiveness evaluations).

CONCLUSIONS

Studies of ML in HF, ACS and AF are limited by number and type of included covariates, ML methods, population size, country, clinical setting and focus on single diseases, not overlap or multimorbidity. Clinical utility and implementation rely on improvements in development, validation and impact, facilitated by simple checklists. We provide clear steps prior to safe implementation of machine learning in clinical practice for cardiovascular diseases and other disease areas.

Self-care status in patients with heart failure: Systematic review and meta-analysis

Aim

To systematically review the status of self‐care in patients with heart failure through the Self‐Care of Heart Failure Index scale.

Design

A systematic review and meta‐analysis.

Methods

Following national and international databases were searched to retrieve eligible studies: PubMed, Web of Science, Embase, Google Scholar, Scientific Information Database and Magiran. The studies were screened and selected by two researchers. Data analysed through the random‐effects model, and the I² index was used to assess heterogeneity. Stata software version 12.0 was used for analysis. The PRISMA statement was used to report systematic review and meta‐analysis.

Results

Of the 5,953 articles initially identified, 39 studies were included. The average score was estimated at 58.16 (CI: 54.39–61.94) for self‐care maintenance, 53.11 (CI: 49.17–57.05) for self‐care management and 58.66 (CI: 54.32–63.00) for self‐care confidence. Despite the high heterogeneity of the studies, the results indicated that self‐care practice is inadequate in all the three dimensions of self‐care (maintenance, management and confidence).

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

Social determinants of health (SDH) are known to influence health. Adequate self-care maintenance improves heart failure (HF) outcomes. However, the relationship between self-care maintenance and SDH remains unclear. Explore the relationship between sociodemographic indicators of social position and self-care maintenance in adults with HF. This was a secondary analysis of data from a cross-sectional descriptive study of 543 adults with HF. Participants completed the Self-Care of HF Index and a sociodemographic survey. We used multiple regression with backward elimination to determine which SDH variables were determinants of self-care maintenance. Marital status (p = .02) and race (p = .02) were significant determinants of self-care maintenance. Education (p = .06) was highest in Whites (35.6%). These variables explained only 3.8% of the variance in self-care maintenance. Race, education, and marital status were associated with HF self-care maintenance. SDH is complex and cannot be explained with simple sociodemographic characteristics.

Cross-cultural adaptation of the caregiver contribution to heart failure self-Care into Brazilian Portuguese and content validation

BACKGROUND

The Caregiver Contribution to Heart Failure Self-Care (CACHS) is a Canadian instrument that assesses caregivers' (CGs) contributions to heart failure (HF) patients' self-care, but a Brazilian version was lacking.

AIMS

To adapt CACHS into Brazilian Portuguese and to estimate the content validity of the adapted version.

METHODS

A psychometric study of cross-cultural adaptation and content validation was conducted. Linguistic equivalence was assessed by eight professional experts. Content validity was assessed by an expert professional panel (n=8; for clarity, theoretical relevance and practical relevance) and a CG panel (n=46; for cognitive debriefing of the adapted instrument). In the cultural adaptation, the items were considered equivalent if experts reached an agreement ≥80%. In the content validation, the items were considered acceptable if content validity coefficients (CVC) were ≥0.70.

RESULTS

The translated version was considered consistent with the original CACHS by the authors. In the second round of linguistic equivalence assessment, all items achieved 100% agreement, except for one item, which presented 75% agreement in conceptual equivalence. The CVC in the first and second rounds of content validity assessment by experts was 0.80 to 0.90. During cognitive testing, the CGs requested explanations on three items, which were reformulated. All CGs then understood the Brazilian version of CACHS, named CACHS - Versão Brasileira (CACHS-Br).

CONCLUSIONS

CACHS-Br is equivalent to the original version and provided satisfactory evidence of content validity. Further psychometric testing of this version should allow for the measurement of the CG contributions to HF self-care in Brazil.

The Self-Care of Heart Failure Index version 7.2: Further psychometric testing

Clinicians and researchers need valid and reliable instruments to evaluate heart failure (HF) self-care. The Self-Care of Heart Failure Index (SCHFI) is a theoretically driven instrument developed for this purpose. The SCHFI measures self-care with three scales: self-care maintenance, measuring behaviors to maintain HF stability; symptom perception, measuring monitoring behaviors; and self-care management, assessing the response to symptoms. After the theory underpinning the SCHFI was updated, the instrument was updated to version 7.2 but it was only tested in the United States. In this study we tested the psychometric characteristics (structural and construct validity, internal consistency, and test-retest reliability) of the SCHFI v.7.2 in an Italian population of HF patients. We used a cross-sectional design to study 280 HF patients with additional data collected after 2 weeks for test-retest reliability. Adults with HF (mean age 75.6 (±10.8); 70.8% in New York Heart Association [NYHA] classes II and III) were enrolled from six centers across Italy. Confirmatory factor analysis showed supportive structural validity in the three SCHFI v.7.2 scales (CFI from 0.94 to 0.95; RMSEA from 0.05 to 0.07). Internal consistency reliability estimated with Cronbach's α and composite reliability ranged between .73 and .88; test-retest reliability ranged between 0.73 and 0.92. Construct validity was supported with significant correlations between the SCHFI v.7.2 scale scores and quality of life, brain natriuretic peptide levels and NYHA class. This study further supports the psychometric characteristics of the SCHFI v.7.2, illustrating that it can be used in clinical practice and research also in an Italian population.

Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness

The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.

The roles of health literacy and social support in improving adherence to self-care behaviours among older adults with heart failure

Aim

To describe the associations between health literacy, social support and self‐care behaviours in older adults with heart failure.

Design

A cross‐sectional descriptive study.

Methods

A total of 252 older adults were recruited from a tertiary care hospital from September 2018–February 2019. Structured questionnaires and medical record reviews were used for data collection. Two steps of hierarchical regression analysis were employed to determine the predictors of self‐care behaviours.

Results

Health literacy (β = 0.27, p < .001) and social support (β = 0.32, p < .001) were significant determinants of self‐care behaviours in older adults with heart failure. Together, they explained 22% of the variance in self‐care behaviours.

Conclusion

Health literacy and perceived social support were positively associated with self‐care behaviours among older heart failure patients. Our findings can help health professionals develop heart failure self‐care interventions to enhance health literacy skills and social support for older adults.

Effects of illness representation-focused patient education on illness representations and self-care in patients with heart failure: A randomised clinical trial

AIMS AND OBJECTIVES

To examine the effect of an illness representation-focused patient education intervention on illness representations and self-care behaviours in patients with heart failure 3 months after discharge from the hospital.

BACKGROUND

Few intervention studies have examined the effect of illness representation-focused interventions on illness representations and self-care in patients with heart failure.

DESIGN

A randomised clinical trial based on the Consolidated Standard of Reporting Trials-CONSORT 2010-guidelines was employed. The Clinical Trial Registry number is TCTR20190903002.

METHODS

One hundred and seven participants were randomly assigned to 2 groups, and 62 participants (n = 30 in the intervention group and n = 32 in the usual care group) completed the baseline and one- and three-month postdischarge follow-up assessments. The instruments included the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index. The intervention group received illness representation-focused patient education while hospitalised and telephone follow-ups after discharge. Data were analysed with linear mixed-effects model analysis.

RESULTS

The 107 participants had a mean age of 62.17 years and a mean left ventricular ejection of 53.03%. At baseline, the two groups tended to have accurate illness beliefs but insufficient self-care confidence and self-care maintenance. The analysis showed no significant differences between groups in the illness representation total scores, dimension scores or self-care maintenance scores but did show a significant difference in the self-care confidence scores (F = 3.42, p < .05) over the three months.

CONCLUSION

The study did not show an effect of the intervention on illness representations or self-care maintenance behaviours. However, the intervention did maintain participants' self-care confidence three months after discharge.

RELEVANCE TO CLINICAL PRACTICE

It is necessary to conduct long-term follow-ups of patients' illness representations, discuss the implementation of self-care behaviours with patients, enhance patients' self-care confidence, and involve family members or caregivers in self-care practices when needed.

Psychometric Testing of the Revised Self-Care of Heart Failure Index

BACKGROUND

Self-care is essential in people with chronic heart failure (HF). The process of self-care was refined in the revised situation specific theory of HF self-care, so we updated the instrument measuring self-care to match the updated theory. The aim of this study was to test the psychometric properties of the revised 29-item Self-Care of Heart Failure Index (SCHFI).

METHODS

A cross-sectional design was used in the primary psychometric analysis using data collected at 5 sites in the United States. A longitudinal design was used at the site collecting test-retest data. We tested SCHFI validity with confirmatory factor analysis and predictive validity in relation to health-related quality of life. We tested SCHFI reliability with Cronbach α, global reliability index, and test-retest reliability.

RESULTS

Participants included 631 adults with HF (mean age, 65 ± 14.3 years; 63% male). A series of confirmatory factor analyses supported the factorial structure of the SCHFI with 3 scales: Self-Care Maintenance (with consulting behavior and dietary behavior dimensions), Symptom Perception (with monitoring behavior and symptom recognition dimensions), and Self-Care Management (with recommended behavior and problem-solving behavior dimensions). Reliability estimates were 0.70 or greater for all scales. Predictive validity was supportive with significant correlations between SCHFI scores and health-related quality-of-life scores.

CONCLUSIONS

Our analysis supports validity and reliability of the SCHFI v7.2. It is freely available to users on the website: www.self-care-measures.com.

The Self-Care of Heart Failure Index: A psychometric study

BACKGROUND

The Self-Care of Heart Failure Index is an empirically tested instrument to measure self-care of heart failure patients across different populations and cultures.

AIMS

To develop and evaluate the psychometric properties of the Nepali Self-Care of Heart Failure Index.

DESIGN

This psychometric study used a cross-sectional, observational, study design to collect data. The study was guided and reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline.

METHODS

To develop and culturally validate Nepali Self-Care of Heart Failure Index, a combination of the recommended methods for cross-cultural validation studies were applied such as translation, back translation, expert committee review of the translated version and validity/reliability testing. Face and content validity were ensured using expert review. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis. Composite reliability scores were calculated for each sub-scale of the Nepali Self-Care of Heart Failure Index.

RESULTS

A total of 221 heart failure patients in Nepal were enrolled in the study. Adequate face and content validity were ensured through expert review. Exploratory factor analysis and confirmatory factor analysis supported the original three-factor model. Although the three factors explained only 41% of the variance, confirmatory factor analysis fit indexes and error measures were found reasonable. The composite reliability coefficients for self-care maintenance, management and confidence scale were 0.6, 0.7 and 0.8, respectively.

CONCLUSIONS

The Nepali Self-Care of Heart Failure Index is a theoretically based, culturally acceptable and appropriate instrument for use among Nepali heart failure patients. However, further studies are needed to refine its psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

Access to reliable, valid and culturally appropriate instruments is crucial in describing the state of the problem as well as for developing and evaluating tailored and targeted self-care practice interventions for Nepali patients living with heart failure.

Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation

Background:

Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.

Methods:

We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.

Results:

A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.

Conclusion:

The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.

Relationship between self-care behaviors and quality of life in patients with heart failure

Background

It has been generally agreed that cardiac failure is one of the common and devastating diseases due to its morbidity, mortality and rates of disability. Moreover, it has negative impacts on quality of life among sufferers. Meanwhile, improving quality of life among heart failure patients is essential. It can be suggested that people with self-care ability have a better quality of life. However, this issue may be affected by some cultural issues. Regarding a paucity of information on this aspect in Iran, this study aims to explore the relationship between self-care behaviors and quality of life in patients with heart failure.

Methods

This study is carried out using a descriptive - analytical method. The sample size consists of 77 patients who consented to participate in the study and had ejection fraction <40%. The tools were demographic checklist, European heart failure self-care behavior scale, and SF-36 quality of life questionnaire. Data was gathered from the heart center of Imam Ali in Kermanshah-Iran. Data analysis was done using independent t-test, Mann Whitney, ANOVA, and Kruskal-Wallis tests by SPSS-24 software.

Findings

The study sample was 77 participants, of which 45 were female and 51 lived in an urban area. The mean of self-care score was 39.42 ± 7.04, and most of the patients (67.5%) were in moderate level. The mean and SD of quality of life was estimated as 38.45 ± 17.28. The spearman correlation test showed no correlation between self-care and quality of life. However there was a correlation between marital status and self-care ability, in which it shows the higher scores in unmarried people (K2 = 7.75, P = 0.021), and the results indicated better quality of life in male (t = 2.68, P = 0.009), educated patients at the level of university (F = 7.60, P < 0.001), free job (F = 6.21, P < 0.001) and lived in the urban area (Z = 2.05, P = 0.04).

Conclusion

In this study, there is no correlation between self-care behaviors and quality of life in which, this may be attributed to Iranian cultures and perspectives such as valuing live with the children and importance of their attention to elderly patients, which demanded more studies.

The American Heart Association Heart Failure Summit, Bethesda, April 12, 2017

The American Heart Association convened a meeting to summarize the changing landscape of heart failure (HF), anticipate upcoming challenges and opportunities to achieve coordinated identification and treatment, and to recommend areas in need of focused efforts. The conference involved representatives from clinical care organizations, governmental agencies, researchers, patient advocacy groups, and public and private healthcare partners, demonstrating the breadth of stakeholders interested in improving care and outcomes for patients with HF. The main purposes of this meeting were to foster dialog and brainstorm actions to close gaps in identifying people with or at risk for HF and reduce HF-related morbidity, mortality, and hospitalizations. This report highlights the key topics covered during the meeting, including (1) identification of patients with or at risk for HF, (2) tracking patients once diagnosed, (3) application of population health approaches to HF, (4) improved strategies for reducing HF hospitalization (not just rehospitalization), and (5) promoting HF self-management.

A Mobile Application for Patients With Heart Failure: Theory- and Evidence-Based Design and Testing

Self-care is vital for the successful management of heart failure. Mobile health can enable patients with heart failure to perform effective self-care. This article describes the theory-guided development and beta testing of a mobile application intervention to support self-care and increase symptom awareness in community-dwelling patients with heart failure. Ten participants entered physiologic data, answered qualitative questions about symptoms, and reviewed heart failure education within the HF App daily. Two validated instruments, the Self-care of Heart Failure Index and Heart Failure Somatic Awareness Scale, were administered both before and after the intervention, and results were compared using t tests. Results indicated that there were clinically significant changes from preintervention to postintervention in self-care scores in each subscale, with a statistically significant difference in the confidence subscale scores (P = .037). However, there were no statistically significant differences between preintervention and postintervention symptom awareness scores. These results indicate that incorporating mobile applications that comprise symptom monitoring, reminders, education, and the ability to track trends in physiologic data is most useful to assist individuals with heart failure to perform effective self-care.

Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

AIM

The aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).

METHODS AND RESULTS

A monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort's demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients' discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient-caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%-18.0%.

CONCLUSION

This study sets the stage for future research where elements of the patient-caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients' self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

Using vignettes to understand heart failure self-care

AIMS AND OBJECTIVES

To explore hospitalised heart failure (HF) patients' self-care decisions.

BACKGROUND

Heart failure self-care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self-care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self-care decision-making.

DESIGN

This qualitative descriptive analysis was conducted as part of a mixed methods study.

METHODS

We conducted semi-structured interviews (N = 20) to elicit patient decisions about self-care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses.

RESULTS

Participants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling.

CONCLUSIONS

Symptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult.

RELEVANCE TO CLINICAL PRACTICE

Vignettes may be a helpful tool to prompt patient-healthcare provider communication about self-care management and prompt discussions about appropriate self-care decisions in response to varying levels of symptom severity.

Relationships between exercise capacity and anxiety, depression, and cognition in patients with heart failure

BACKGROUND

Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.

OBJECTIVES

The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.

METHODS

This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.

RESULTS

The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.

CONCLUSIONS

The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients.

Patient activation with respect to advanced heart failure therapy in patients over age 65 years

BACKGROUND

Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including "activation" (engagement and ability to self-manage).

OBJECTIVE

To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy.

METHODS

Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy.

RESULTS

Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression.

CONCLUSIONS

Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy.

Nursing research in heart failure care: a position statement of the american association of heart failure nurses (AAHFN)

BACKGROUND

Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.

OBJECTIVES

A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.

METHODS

A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.

RESULTS

Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.

CONCLUSIONS

Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.

Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update

Purpose of the Review

As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful.

Recent Findings

Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients.

Summary

Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.

Detecting and Managing Cognitive Impairment to Improve Engagement in Heart Failure Self-Care

PURPOSE OF THE REVIEW

The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care.

RECENT FINDINGS

Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.

Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up

BACKGROUND

Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF self-care to clinical events.

OBJECTIVES

To identify patterns of self-care behaviors in HF patients and their association with clinical events.

METHODS

This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n = 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up.

RESULTS

Patients (mean age 71.8 ± 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio = 0.66 [0.46-0.96], p = 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events.

CONCLUSIONS

Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients.

Self-Efficacy and Health-Related Quality of Life Among Heart Failure Patients in Singapore: A Descriptive Correlational Study

Introduction: Heart failure (HF) accounts for 30% of all global deaths and Asians are likely to suffer from HF 10 years earlier than their Western counterparts. Low self-efficacy and poor health-related quality of life (HRQoL) have been reported in patients with HF. Methodology: A descriptive correlational design was adopted to investigate the associations between self-efficacy and HRQoL in 91 patients with HF in Singapore. Results: Patients with HF demonstrated moderately good self-efficacy ( M = 3.05, SD = 0.61) and HRQoL ( M = 22.48, SD = 18.99). Significant differences were found between total self-efficacy scores and education levels ( p = .05), and between overall HRQoL and smoking status ( p < .05). Self-efficacy was not significantly correlated to HRQoL. Smoking status, HF classification, and self-efficacy in maintaining function predicted HRQoL. Discussion: Health care professionals should assess each patient’s demographics, smoking status, and clinical condition before delivering individualized education to enhance their self-efficacy and, in turn, overall HRQoL.