Abstract
Background:Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.Aims:(1) To describe the trajectory of patients’ self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.Methods:In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.Results:Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).Conclusion:Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.
Highlights
Self-care behaviour is key to enhancing health-related quality of life (HRQoL) and to reduce mortality and morbidity among heart failure (HF) patients, but self-care behaviour remains suboptimal in many patients worldwide.[3,4,5]
The purpose of this study was (1) to describe the trajectory of HF patients according to changes in self-care behaviour, (2) to examine the relationship between changes of self-care and subsequent clinical outcomes over time, and (3) to identify factors related to change in self-care behaviour
Our major findings were that (1) one in five patients had persistently poor self-care behaviour despite self-care education and follow-up at an HF clinic or by a general practitioner (GP), and a third of the patients decreased in self-care behaviour, (2) patients who decreased in selfcare had worse clinical outcomes and (3) the presence of depression and low perceived control were factors significantly related to poor or decreased self-care behaviour
Summary
Despite advances in heart failure (HF) treatment and organisation of care, HF outcomes still remains poor, with post discharge mortality rates up to 15%, 20–30% readmission rates within the first 30 days after discharge, and health-related quality of life (HRQoL) poorer than many other chronic conditions.[1,2]Self-care behaviour is key to enhancing HRQoL and to reduce mortality and morbidity among HF patients, but self-care behaviour remains suboptimal in many patients worldwide.[3,4,5] Self-care is a complex process of maintaining health through health-promoting activities and by European Journal of Cardiovascular Nursing 19(5)managing illness, e.g. by exercising, monitoring body weight, taking prescribed medication, and seeking a healthcare provider when symptoms are deteriorating.[6]. Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). Conclusion: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour
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