Abstract 10274: It’s Complicated: Comorbidity, Self-efficacy, Self-care When Hospitalization and Quality of Life are Outcomes in Heart Failure

Abstract

Introduction: Essential elements of heart failure (HF) self-care include engagement in daily behaviors that maintain physical stability (self-care maintenance) and recognition of symptoms with a timely response (self-care management). Comorbidity decreases self-efficacy or confidence in the ability to perform self-care which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization and poorer quality of life (QOL). Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and QOL remains unclear. Hypotheses: 1) Comorbidity and self-efficacy are determinants of self-care maintenance and management which in turn are determinants of hospitalization and QOL; 2) Comorbidity moderates the relationship between self-efficacy and self-care maintenance and management. Methods: An existing dataset of 628 symptomatic, older (mean age = 73, SD = 11) male (58%) Italian HF patients was analyzed using structural equation modeling and simple slope analysis. Measures used were the Charlson Comorbidity Index; Self-Care of Heart Failure Index (V6.2) for self-efficacy, self-care maintenance and self-care management; medical record review for hospitalization; and Minnesota Living with Heart Failure Questionnaire for QOL. Results: In the model higher comorbidity was associated with lower self-care management but not maintenance. Higher self-efficacy was associated with both higher self-care maintenance and management. Higher self-care maintenance was associated with fewer hospitalizations and better overall QOL. In the moderation analysis comorbidity moderated the relationship between self-efficacy and self-care maintenance. Higher comorbidity weakened the strength of the relationship between self-efficacy and self-care maintenance in post-hoc simple slopes analysis. Conclusions: The strength of the relationship between self-efficacy and self-care maintenance was a function of comorbidity. Self-care maintenance was associated with hospitalization and QOL. Therefore, tailoring interventions to improve self-efficacy at different levels of comorbidity may be key to impacting hospitalization and QOL in HF.