Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47-13.43), illiteracy (AOR: 2.64, 95% CI: 1.52-6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21-3.61), and taking five or more medications (AOR: 1.83, 1.01-3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association

Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy

BACKGROUND

Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD).

METHOD

This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion.

RESULTS

The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL.

CONCLUSION

The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Self-care in the older adult population with chronic disease: concept analysis

Purpose

Chronic disease care is considered a challenging dilemma for health organizations’ sustainability and patient health. Self-care is key to chronic disease management and is substantially important in all aspects of health and levels of care. In the past years, research regarding self-care in the context of chronic disease has evolved, yet this complex concept continues to be ambiguous as there are differences in the way self-care is clearly conceptualized in the literature. A discussion of an in-depth concept analysis of self-care in the older adult population with chronic disease and an outline of its defining common attributes, referents, antecedents, consequences, and related concepts.

Design

Qualitative concept analysis concerning the concept of self-care in the older adult population with chronic disease.

Methods

An extensive review of the literature concerning the concept of self-care in the older adult population with chronic disease was conducted using different databases. Literature from nursing and other disciplines was selected to differentiate this concept from other related concepts. Rodgers's evolutionary methodology of concept analysis was used to investigate the concept of self-care in detail to better understand its meanings in the context of chronic disease.

Results

Multiple definitions of self-care exist, and a consensus definition was not shown to have been achieved across disciplines. The common attributes, referents, antecedents, consequences, and related concepts were identified, and a model case was constructed by the authors to clarify the concept of self-care in the context of the older adult population living with chronic disease. This concept analysis provides a theoretical definition of self-care of the older adult population living with chronic disease to offer nurses and others insight into the concept, which will ultimately provide a foundation for further research needed in the areas of clinical practice, policy, and education. Identification of the core of the self-care concept affords professionals and researchers the ability to identify appropriate practice priorities, enhance current practices, and develop theories and guidelines regarding self-care, leading to improvements in patient care and outcomes.

•

Self-care is supported in the literature as an approach toward the attainment and sustainment of optimal health.

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The common attributes, referents, antecedents, consequences, and related concepts were identified.

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A clearer conceptual understanding was established of how self-care will support nursing research and clinical leadership.

Predictors of Self-care Among Chinese Patients With Chronic Heart Failure

BACKGROUND

Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society.

OBJECTIVE

The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care.

METHODS

A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model.

RESULTS

In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors ( P < .05). These associations were partly or fully mediated by self-care confidence.

CONCLUSION

The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.

Factors related to self-care behaviors among hospitalized patients with heart failure in Japan, based on the European Heart Failure Self-Care Behaviour Scale

[Purpose] The characteristics of heart failure in hospitalized patients with poor self-care behaviors are unknown. We investigated factors associated with self-care behaviors by using the European Heart Failure Self-Care Behaviour Scale (EHFScBS) in heart failure patients based on three comprehensive concepts. [Participants and Methods] This was a cross-sectional single-center study of heart failure patients hospitalized at a tertiary-care hospital. We investigated age, gender, family living together/apart, employment, and the Specific Activity Scale (SAS). A physical therapist provided the EHFScBS one time to determine the patients’ pre-hospital self-care behavior status. The 12 items of the EHFScBS were classified into the following three categories: Maintenance, Monitoring, and Management. [Results] The median age of the 39 consecutive patients was 81 years. A multiple regression analysis revealed that the factors exhibiting significant associations were the SAS score (β=0.504) for Management and age (β=−0.403) for the total EHFScBS score (adjusted by the number of hospitalizations for heart failure). Maintenance and Monitoring were not significantly associated with the survey items. [Conclusion] These data indicate that self-care education for hospitalized patients with heart failure leads to individualized approaches based on characteristics such as age and physical activity capacity.

Association of depression and anxiety with adherence in primary care patients with heart failure-cross-sectional results of the observational RECODE-HF cohort study

BACKGROUND

Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients' adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence.

METHOD

This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence.

RESULTS

Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence.

CONCLUSION

Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients' self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.

The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model

BACKGROUND

Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood.

OBJECTIVES

The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care.

METHODS

Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis.

RESULTS

Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized.

CONCLUSIONS

Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.

Health-related quality of life and extent of self-care practice among heart failure patients in Ethiopia

Background

Heart Failure (HF) results in an immense impact on the patients’ Health-related quality of life (HRQOL). Heart failure patients HRQOL is dependent on the patients’ level of engagement in self-care behaviors. Therefore this study aimed to determine HF patients’ health-related quality of life and its relationship with self-care behaviors.

Methods

An institutional-based study was conducted on 284 heart failure patients at the University of Gondar referral hospital. The data were collected using a structured questionnaire-based interview. The data were analyzed using SPSS version 20. Both descriptive and analytical statistical tests were utilized. A multinomial logistic regression analysis was done to determine the association between HRQOL and different independent variables. Variables with a p-value< 0.05 were considered as a significant predictor of the outcome variable.

Results

The finding of this study showed that more than sixty-six percent of the study population were females. The overall mean score of HF patients’ quality of life was 46.4 ± 22.4 and the physical and emotional subscale mean score was 20.2 ± 9.8 and 10.5 ± 6.8 respectively. The majority of the study participants 147(51.8%) had poor quality of life. The multinomial logistic regression analysis result showed that rural residence (odds ratio 2.41, 95% CI, 1.23 to 4.71) and inadequate level of self-care practice (odds ratio 2.61, 95% CI, 1.43 to 4.78) were independent predictors of poor HRQOL. The correlation analysis also showed that there was a significant negative relationship between HF patients’ HRQOL score and Self-care practice score (r = − 0.127, P = 0.032).

Conclusion

Overall, the majority of HF patients had poor HRQOL. Heart failure patients’ HRQOL was significantly associated with place of residence and patients’ level of self-care practice. Therefore, patients with HF are required to learn the benefit of self-care behaviors to improve their quality of life and to decrease the disease progression. Furthermore, HF patients who come from rural areas need special emphasis in each follow-up evaluation.

Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure

BACKGROUND

Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL.

OBJECTIVE

The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL.

METHODS

In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire).

RESULTS

The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL.

CONCLUSION

In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.

Self-care confidence mediates self-care maintenance and management in patients with heart failure

BACKGROUND

Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care.

OBJECTIVES

To examine whether confidence explained the associations of social support and HF-knowledge with self-care.

METHODS

In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care.

RESULTS

Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144).

CONCLUSION

Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.

Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

The suitability of motivational interviewing versus cognitive behavioural interventions on improving self-care in patients with heart failure: A literature review and discussion paper

BACKGROUND

Chronic heart failure remains a major public health concern due to its high prevalence and disease burden. Although self-care has been advocated as the sustainable solution, it remains inadequate. Recent studies have shown the potential of integrating structured counselling elements into traditional educational programs to enhance self-care but the optimal counselling method remains unclear.

AIM

To compare the applicability of cognitive behavioural interventions and motivational interviewing on improving self-care behaviours in patients with chronic heart failure.

METHOD

A systematic three-step search strategy was used to identify studies that incorporated cognitive behavioural interventions and/or motivational interviewing to improve heart failure self-care. Quantitative and qualitative trial studies that met the inclusion criteria were appraised using the Joanna Brigg's Institute criteria.

RESULTS

Motivational interviewing showed higher potential in improving HF self-care behaviours, but sustainability remains unclear. Cognitive behavioural interventions only showed effectiveness when applied to patients with comorbid depressive symptoms. Statistically significant results were only elucidated upon statistical adjustments and examination of behaviours individually. Potential effective components of CBI include setting up environmental reminders, addressing misconceptions and skills-training while that of MI was the communication style.

CONCLUSION

MI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours. MI could be used to enhance the intention to change by evoking ambivalence and change talk. CBI could be used to enhance problem-solving skills and set environmental reminders to strengthen the translation of intention to behaviour.

The Most and the Least Performed Self-Care Behaviors Among Patients With Heart Failure in Jordan

Assessing self-care is important aspects among patients with heart failure. However, few studies were conducted to assess self-care among patients with heart failure in Jordan. Therefore, this study aimed to assess the most and the least performed maintenance self-care behaviors and to examine the relationship between maintenance self-care behaviors and selected sociodemographics. A cross-sectional design utilizing a convenience sample of 226 patients with heart failure was used. The maintenance self-care mean was 53.89 and considered below the clinical target level (≥70). Asking for low salt item and performing physical exercises were the most performed self-care behaviors, while "trying to avoid getting sick" and "checking ankles for swelling" were the least performed self-care behaviors. Limited self-care behaviors indicated the need to implement cardiac education that may improve self-care behaviors. Cardiac education should target mainly patients with low income, low educational level, elderly, living alone, unemployed, and who are using traditional treatment.

Heart failure self-management and normalizing symptoms: an exploration of decision making in the community

OBJECTIVE

To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.

BACKGROUND

Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations. Despite education, some patients fail to seek timely medical intervention when symptoms change.

METHODS

Semi-structured interviews were conducted with homecare patients after receiving self-management education. Grounded theory methods and qualitative software were used to collect and analyze the data.

RESULTS

Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity. Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.

CONCLUSIONS

Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration.

The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure

BACKGROUND

Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.

OBJECTIVE

The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.

METHODS

A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.

RESULTS

Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.

CONCLUSIONS

Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients' SM confidence.

Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model

BACKGROUND

While comprehensive evidence exists regarding negative effects of depression on self-care behaviours in patients with chronic heart failure (CHF), the relation between anxiety and self-care behaviours in patients with CHF is not clear. The aim of this study was to analyse the interactions between anxiety, depression and self-care behaviours in patients with CHF.

METHODS

The self-care behaviour of CHF outpatients was measured using the European Heart Failure Self-care Behaviour Scale (EHFScBS). The Patient Health Questionnaire (PHQ) was used to assess anxiety, the PHQ-9 was used to measure depression severity. Differences between patients with and without anxiety were assessed with the respective tests. Associations between anxiety, self-care and other predictors were analysed using linear regressions.

RESULTS

Of the 308 participating patients, 35 (11.4%) fulfilled the PHQ criteria for an anxiety disorder. These patients took antidepressants more frequently (11.8% versus 2.3%, p = .02), had had more contacts with their general practitioner within the last year (11.8 ± 16.1 versus 6.7 ± 8.6, p = .02), and had a higher PHQ-9 depression score (12.9 ± 5.7 versus 6.5 ± 4.7, p < .01) than patients without anxiety disorder. Anxiety and self-care were negatively associated (ß = -0.144, r² = 0.021, p = 0.015). The explanation of variance was augmented in a multivariate regression with the predictors age, sex, education, living with a partner, and New York Heart Association (NYHA) class ( r² = 0.098) when anxiety was added ( r² = 0.112). Depression further increased the explanation of variance (ß = -0.161, r² = 0.131, p = 0.019).

CONCLUSIONS

Anxiety is negatively associated with self-care behaviour in patients with CHF. However, this effect disappears behind the stronger influence of depression on self-care. The consideration of mental comorbidities in patients with CHF is important.

Self-Care Among Older Adults With Heart Failure

Background: It is estimated that 5.7 million Americans are living with heart failure (HF) today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population. Purpose: The purpose of the study was to review the current literature on self-care in this population to better understand the influence of selected factors on self-care and health outcomes. Methods: A literature search was completed and resulted in including 28 studies. Results: Multiple factors have been reported as barriers to self-care including depression and presence of peripheral arterial disease. Factors having a positive effect on self-care are male gender, number of cardiologist referrals, and self-efficacy. There were few studies that described the association between cognitive functioning and self-care. There is a lack of strong evidence to support the association between self-care and health outcomes such as readmission rate, but recent studies suggest that a 30-day readmission is not a valid predictor of health outcomes. Implications: The assessment of the psychological factors and health care resource utilization patterns that may influence self-care is recommended. More research that addresses the role of cognitive factors in influencing self-care is needed.

[Heart failure in primary care: Attitudes, knowledge and self-care]

Objetivo

Conocer actitudes, conocimientos y prácticas en autocuidado en pacientes con insuficiencia cardiaca (IC) atendidos en atención primaria, e identificar factores asociados a mayor autocuidado.

Diseño

Estudio transversal multicéntrico.

Emplazamiento

Atención primaria.

Participantes

Individuos mayores de 18 años con diagnóstico activo de IC a 1 de diciembre de 2011 en 10 centros de salud del Área Metropolitana de Barcelona.

Medidas principales

Se realizó entrevista y revisión de historia clínica para obtención de datos sociodemográficos, clínicos y tests de actitudes (Self-efficacy Managing Chronic Disease Scale), conocimientos (Patient Knowledge Questionnaire), autocuidado (European Heart Failure Self-care Behaviour Scale), grado autonomía (Barthel) y cribado ansiedad-depresión (test Goldberg). Se analizaron las variables asociadas a autocuidado mediante modelo de regresión lineal múltiple de efectos mixtos jerarquizado por centros.

Resultados

n = 295 individuos (77,6%), edad media 75,6 años (DE: 11), 56,6% mujeres, 62% sin estudios primarios. Se obtuvo una media global de autocuidado de 28,65 (DE: 8,22) puntos. Un 25% de los pacientes presentaron puntuaciones inferiores a 21 puntos. En el modelo multivariante final (n = 282; R² condicional = 0,3382), un mayor autocuidado se relacionó con mejores conocimientos sobre la IC (coeficiente −1,37; intervalo de confianza 95%: −1,85 a −0,90) y el diagnóstico de cardiopatía isquémica (−2,41; −4,36: −0,46).

Conclusiones

El grado de prácticas en autocuidado es moderado. La asociación de mejor autocuidado y mayor nivel de conocimientos sobre la IC, potencialmente modificables, subraya la oportunidad de implementar estrategias para su mejora adaptadas a las características diferenciales de los pacientes con IC atendidos de atención primaria.

Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies

BACKGROUND

Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing.

AIMS

The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS.

METHODS

Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored.

RESULTS

We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies.

CONCLUSION

A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors.

Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice

Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.

Type D personality negatively associated with self-care in Chinese heart failure patients

BACKGROUND

Little is known about the association between type D personality and self-care behaviors in heart failure (HF) patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients.

METHODS

A cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index (V6) and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The methods used for data analysis included descriptive analysis, independent-sample t-test, χ (2) test, and multiple linear regression.

RESULTS

A total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9 ± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV (87%), and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors.

CONCLUSIONS

Type D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality.

Psychological Determinants of Heart Failure Self-Care: Systematic Review and Meta-Analysis

OBJECTIVE

Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF.

METHODS

Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models.

RESULTS

Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44).

CONCLUSIONS

Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.

Mechanism of engaging self-management behavior in rural heart failure patients

AIM

The purpose of this study was to examine the relationships among self-efficacy, patient activation and SM in rural heart failure patients discharged from critical access hospitals.

BACKGROUND

Heart failure is one of the most disabling and resource-consuming chronic conditions. Compared to their urban counterparts, rural heart failure patients had higher healthcare utilizations and worse health outcomes. Self-management (SM) plays a significant role in improving patients' outcomes and reducing healthcare use. Despite persistent recommendations of SM, engagement in SM still remains low in rural heart failure patients. SM is a complex behavior, which is influenced by various factors. Evidence on the efficacy of interventions to promote SM is limited and inconsistent. One reason is that the mechanism of engagement of SM in the rural heart failure population has not been fully understood.

METHODS

A correlational study was conducted using secondary data from a randomized control trial aimed to improve SM adherence. Path analysis was used to test the hypothesis of patient activation mediating the effect of self-efficacy on SM.

RESULTS

Data were collected from a sample of 101 heart failure patients (37% males) with an average age of 70 years. The final model provided a good fit to the data, supporting the hypothesis that self-efficacy contributes to SM through activation.

CONCLUSION

The results of this study showed that effective SM interventions should be designed to include strategies to promote both self-efficacy and activation.

Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis

Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.

Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care

BACKGROUND

Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization rates and poorer quality of life. Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and quality of life remains unclear.

OBJECTIVES

The purpose of this study was to test an explanatory model. The research questions were (1) What is the contribution of comorbidity to heart failure self-care behaviors and outcomes (i.e. hospitalization, quality of life)? and (2) Is comorbidity a moderator of the relationship between self-efficacy and heart failure self-care behaviors?

DESIGN

This was an analysis of an existing dataset of 628 symptomatic, older (mean age=73, standard deviation (SD)=11) male (58%) Italian heart failure patients using structural equation modeling and simple slope analysis.

RESULTS

Higher levels of self-care maintenance were associated with higher quality of life and lower hospitalization rates. Higher levels of comorbidity were associated with lower levels of self-care management. Comorbidity moderated the relationship between self-efficacy and self-care maintenance, but not self-care management. Post hoc simple slopes analysis showed significantly different slope coefficients (pdiff<.05). Specifically, in patients with less comorbidity, the relationship between self-efficacy and self-care was significantly stronger than in patients with higher comorbidity.

CONCLUSIONS

Self-efficacy is important in the self-care maintenance process at each level of comorbidity. Because higher comorbidity weakens the strength of the relationship between self-efficacy and self-care maintenance, tailoring interventions aimed at improving self-efficacy to different levels of comorbidity may be key to impacting hospitalization and quality of life.

Implementing guideline based heart failure care in the Northern Territory: challenges and solutions

The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.

Practical guide on home health in heart failure patients

Introduction

Chronic heart failure is a common condition affecting up to 15 million people in the extended Europe. Heart failure is burdensome and costly for patients in terms of decreased quality of life and poor prognosis, and it is also costly for society. Better integrated care is warranted in this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure.

Method

We developed a guide on Home Health in Heart Failure patients from a literature review, a survey of heart failure management programs, the opinion of researchers and practitioners, data from clinical trials and a reflection of an international expert meeting.

Results

In integrated home care for heart failure patients, it is advised to consider the following components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment.

Discussion

We summarised the state of the art of home-based care for heart failure patients in Europe, described the typical content of such care to provide a guide for health care providers.