Comorbid Renal Disease and Treatment Adherence Are Determinants of Symptom Recognition and Treatment in Patients with Symptomatic Heart Failure

Abstract

Introduction: While several determinants of self-care maintenance (treatment adherence) have been identified in the heart failure (HF) population, the determinants of HF self-care management (symptom recognition and treatment) are largely unknown. Hypothesis: Sociodemographic and clinical data are useful as predictors of self-care management. Methods: Data from symptomatic, community-dwelling out-patients with HF enrolled in a prospective cohort study examining the impact of daytime sleepiness on HF self-care were used to test the hypothesis. Sociodemographic and clinical data were collected at enrolment. Self-care maintenance and management were measured with the Self-Care of Heart Failure index (SCHFI). SCHFI maintenance and management scales are standardized to range from 0-100 with higher scores indicating better self-care; SCHFI scores ≥70 are considered adequate. Multiple regression modeling was used to evaluate the influence of sociodemographic and clinical characteristics on self-care management. Results: The sample (n=73) was in older adulthood (mean age 64 ± 12 years), predominantly male (64.4%) and Caucasian (68.5%); half (49.3%) had diabetes mellitus, a majority (65.8%) had hypertension, and about 1/3rd of the sample (28.8%) had renal disease. The majority had systolic HF (60.3%) of ischemic origin (50.7%); the average EF was 35.1%±18.7%, and the majority (64.4%) had NYHA class III HF. SCHFI maintenance scores were adequate (70.6 ± 14.5) and self-care management scores were generally poor (65.4 ± 22.4). Age, gender, ethnicity, level of education, marital status, comorbid diabetes and hypertension, HF type and etiology, EF, and NYHA class were not significant determinants of self-care management individually or in combination. In contrast, comorbid renal disease (β=3.3, 95%CI=.05-6.55, p=.047) and higher levels of self-care maintenance (β=.64, 95%CI=.31-.98, p<.001) were determinants of better self-care management, together explaining 19% of the variance self-care management (F=8.21, p=.001). Conclusions: Comorbid renal disease is associated with better HF self-care management, indicating that patients with renal disease are better at recognizing HF signs and symptoms and engaging in treatment strategies. Level of engagement in self-care maintenance also is a significant determinant of HF symptom recognition and treatment, indicating that HF patients who are better at adhering to prescribed treatment and symptom monitoring also are better at recognizing and treating HF symptoms when they occur. Introduction: While several determinants of self-care maintenance (treatment adherence) have been identified in the heart failure (HF) population, the determinants of HF self-care management (symptom recognition and treatment) are largely unknown. Hypothesis: Sociodemographic and clinical data are useful as predictors of self-care management. Methods: Data from symptomatic, community-dwelling out-patients with HF enrolled in a prospective cohort study examining the impact of daytime sleepiness on HF self-care were used to test the hypothesis. Sociodemographic and clinical data were collected at enrolment. Self-care maintenance and management were measured with the Self-Care of Heart Failure index (SCHFI). SCHFI maintenance and management scales are standardized to range from 0-100 with higher scores indicating better self-care; SCHFI scores ≥70 are considered adequate. Multiple regression modeling was used to evaluate the influence of sociodemographic and clinical characteristics on self-care management. Results: The sample (n=73) was in older adulthood (mean age 64 ± 12 years), predominantly male (64.4%) and Caucasian (68.5%); half (49.3%) had diabetes mellitus, a majority (65.8%) had hypertension, and about 1/3rd of the sample (28.8%) had renal disease. The majority had systolic HF (60.3%) of ischemic origin (50.7%); the average EF was 35.1%±18.7%, and the majority (64.4%) had NYHA class III HF. SCHFI maintenance scores were adequate (70.6 ± 14.5) and self-care management scores were generally poor (65.4 ± 22.4). Age, gender, ethnicity, level of education, marital status, comorbid diabetes and hypertension, HF type and etiology, EF, and NYHA class were not significant determinants of self-care management individually or in combination. In contrast, comorbid renal disease (β=3.3, 95%CI=.05-6.55, p=.047) and higher levels of self-care maintenance (β=.64, 95%CI=.31-.98, p<.001) were determinants of better self-care management, together explaining 19% of the variance self-care management (F=8.21, p=.001). Conclusions: Comorbid renal disease is associated with better HF self-care management, indicating that patients with renal disease are better at recognizing HF signs and symptoms and engaging in treatment strategies. Level of engagement in self-care maintenance also is a significant determinant of HF symptom recognition and treatment, indicating that HF patients who are better at adhering to prescribed treatment and symptom monitoring also are better at recognizing and treating HF symptoms when they occur.