Self-Care and Pathophysiological Function in Patients with Chronic Heart Failure

Dionne Kessing,Nina Kupper,Johan Denollet,Jos Widdershoven

doi:10.1007/s12529-019-09822-2

Abstract

BackgroundSelf-care is assumed to benefit physiological function associated with prognosis in patients with chronic HF, but studies examining these relations are lacking. This study aims to prospectively examine the association of self-reported HF self-care with HF-associated pathophysiological markers, including renal, hematological, and immune function.MethodPatients with chronic HF (n = 460, 66.2 ± 9.6 years, 75% men) completed questionnaires and provided blood samples at baseline and 12-month follow-up. Linear mixed models examined random intercept and fixed between- and within-subjects effects of global self-care and the individual self-care behaviors on log-transformed TNF-α, IL-6, and IL-10, the glomerular filtration rate of creatinine (GFRcreat), and hemoglobin (Hb), controlling for sociodemographic and clinical covariates.ResultsSelf-care was independently associated with lower GFRcreat levels (β = − .14, P = .023) and improvement in self-care with a reduction in GFRcreat (β = − .03, P = .042). Individual self-care behaviors were differentially associated with renal, inflammatory, and hematological markers. Regular exercise was associated with level differences in IL-6 (P < .001), and improvement in exercise was associated with increasing GFRcreat (P = .002) and increasing Hb (P = .010). Fluid restriction was associated with lower overall GFRcreat (P = .006), and improvement in fluid restriction was associated with decreasing GFRcreat (P = .014). Low-sodium intake was associated with lower levels of Hb (P = .027), lower TNF-alpha (P = .011), and lower IL-10 (P = .029). Higher levels of medication adherence were associated with reduced pro-inflammatory activation (P < .007).ConclusionOur findings suggest that better global self-care was associated with poorer renal function. Performing self-care behaviors such as regular exercise and medication adherence was associated with improved physiological functioning, while restriction of fluid and sodium, and the associated daily weight monitoring were associated with adverse levels of pathophysiological biomarkers.

Highlights

Chronic heart failure (HF) is among the leading causes of mortality in developed countries, affecting about 15 million people across Europe [1, 2]
With respect to clinical characteristics, excluded patients were characterized by a poorer left ventricular ejection fraction (LVEF) (30% vs. 32%, P = .016) and increased prescription of diuretics (85% vs. 73%, P = .016) compared with included patients
GFRcreat glomerular filtration rate of creatinine, IL interleukin, TNF-α tumor necrosis factor alpha. This is the first prospective study that examined the association of HF self-care and important pathophysiological processes related to inflammation, cardiorenal, and hematological function in patients with chronic HF

Summary

Introduction

Chronic heart failure (HF) is among the leading causes of mortality in developed countries, affecting about 15 million people across Europe [1, 2]. (2019) 26:629–644 medical treatment, patients with HF are recommended to perform a complex regimen of multiple self-care behaviors (i.e., sodium and fluid restriction, regular exercise, medication adherence, monitoring and consulting for HF symptoms) [6]. Self-care is assumed to benefit physiological function associated with prognosis in patients with chronic HF, but studies examining these relations are lacking. This study aims to prospectively examine the association of self-reported HF selfcare with HF-associated pathophysiological markers, including renal, hematological, and immune function. Individual self-care behaviors were differentially associated with renal, inflammatory, and hematological markers. Performing self-care behaviors such as regular exercise and medication adherence was associated with improved physiological functioning, while restriction of fluid and sodium, and the associated daily weight monitoring were associated with adverse levels of pathophysiological biomarkers

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