Suboptimal self-care trajectories of patients with coronary heart disease call for multiple levels of interventions: results from a longitudinal survey study

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Akureyri Research Fund Landspitali University Hospital Science Fund. Background Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we have limited knowledge about how self-care of CHD changes over time. The purpose of this prospective, longitudinal survey study was to determine if distinct trajectories of change in self-care behaviors could be identified following a hospitalization for CHD, and identify which characteristics are helpful in predicting trajectory membership. Methods Patients hospitalized acutely or electively for CHD were included in the study and completed questionnaires at hospital discharge and 6 months later. Self-care was measured with the Self-Care of Coronary Heart Disease Inventory, version 2.2 which consisted of 2 behavioral subscales (i.e., maintenance and management) that were standardized to range from 0-100 with higher scores indicating better self-care. Symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and health literacy with the Health Literacy Survey Questionnaire. Latent growth mixture modeling was used to identify distinct trajectories of CHD self-care behaviors over time. Results A total of 430 patients with CHD completed the study (mean age 64.3 ±8.9, 79% male). Overall, self-care was poor at enrollment (maintenance 61.6±15.4, management 53.5±18.5). Two trajectories of self-care behaviours were identified. The first "worse CHD self-care" trajectory (57.2% of the sample) had comparatively worse self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (4.0±14.5-point improvement, p<0.001) but self-care management got worse (6.3±24.4-point worsening, p = 0.005) over time in this trajectory. The second "better CHD self-care" trajectory (42.8% of the sample) had comparatively better self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (5.0±16.2-point improvement, p<0.001), and self-care management remained unchanged (0.8±21.9-point worsening, p = 0.713) in this trajectory (Figure 1). Predictors of fitting in the "worse CHD self-care" trajectory were older age, lower education, not having prior CHD hospitalizations, worse depression and anxiety symptoms, lower health literacy, and not participating in rehabilitation after hospitalization. Conclusion The determinants of change in CHD self-care overtime are complex and include multiple levels of potential intervention including health systems (e.g. rehabilitation) and individual care (e.g. red flags of poor literacy and affective symptoms). As such, care models which provide sufficient patient education, address mental health and focus on self-care management might help patients improve their self-care behaviour.Trajectories of self-care