Trajectory of self-care in people with stable heart failure and insomnia after two self-care interventions

To describe (1) self-care trajectories among adults with heart failure (HF) and insomnia over 1-year; (2) the extent to which trajectories varied between cognitive behavioral therapy for insomnia (CBT-I) or HF self-care intervention; and (3) the associations between self-care trajectories and clinical and demographic characteristics, sleep, symptoms and stress, and functional performance. We conducted secondary analysis of data from a randomized controlled trial of the effects of CBT-I compared with HF self-care education among adults with stable HF and insomnia. We used the Self-Care of Heart Failure Index v6.2. The analytic approaches included t-tests, group-based trajectory modeling, ANOVA, and chi-square. We included 175 participants (M age=63.0 (12.9) years, White, N=100]. We found four self-care trajectories: Low self-care (N=47, 26.8%); Moderate self-care (N=68, 38.9%): Adequate self-care (N=42, 24.0%); and Optimal self-care (N=18, 10.3%). There was no difference in self-care trajectories between interventions. The low self-care group had the most severe baseline fatigue, anxiety, and perceived stress, and lowest cognitive abilities. Both interventions prevented declining self-care. Future research is needed to determine the most efficacious intervention to improve self-care trajectories. Healthcare providers should provide ongoing self-care support for those with persistently low and moderate self-care.