European Heart Failure Self-care Behaviour Research Articles

Empowering self-management: exploring self-care practices in heart failure patients

Background and Aim: Heart failure (HF) is a complex clinical syndrome in which ventricular filling and beating functions are impaired. HF also causes psychosocial and economic problems and is a significant public health problem affecting the quality of life. Effective self-care (SC) is a non-pharmacological method that contributes to treatment, improves the patient's quality of life, and reduces repeated hospitalizations and economic burdens. Our study aimed to evaluate self-care in HF patients and to determine the factors affecting SC.
 
 Materials and methods: A total of 100 patients with HF, including 36 women and 64 men, were included in the study. Data were collected by using the Descriptive Information Form and the European Heart Failure Self-Care Behavior Scale in one-on-one interviews with patients under appropriate physical conditions.
 
 Results: Our findings indicate that a range of factors, including age, hypertension, educational status, the total number of comorbid diseases, and the use of certain medications such as SGLT-2 inhibitors, differently impact SC behaviors. SC behaviors were found to be adequate in the study population
 
 Conclusion: We identified essential factors that affect SC in HF patients. We have identified critical factors such as age, educational status, hypertension, comorbidity, and particularly the use of SGLT2 inhibitors, as key influencers of SC practices. For this reason, patient-centered healthcare models should be developed and considered by medical practitioners.

Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47–13.43), illiteracy (AOR: 2.64, 95% CI: 1.52–6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21–3.61), and taking five or more medications (AOR: 1.83, 1.01–3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment.

Postpartum quality of life (QoL) in women with heart disease has been neglected. To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns. The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression. This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525). Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis.

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool. In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security. The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed. ClinicalTrials.gov: NCT04955600.

Comparing the Effects of Face-to-Face and Virtual Self-Care Training Methods on Self‐Care and Quality of Life among Patients with Heart Failure: A Randomized Clinical Trial Study

Background and Objective: Heart failure is one of the most common chronic, progressive, and debilitating heart disorders, exerting a destructive effect on self-care and quality of life in these patients. The present study aimed to compare the effects of face-to-face and virtual self-care training methods on self‐care and quality of life among patients with heart failure. Materials and Methods: This three-group clinical trial study was conducted on 120 patients with heart failure admitted to Farshchian Hospital in Hamadan. The samples were selected via the available sampling method and assigned to three groups (control, virtual, and face-to-face education) using permuted block randomization. Demographic characteristics form, European Heart Failure Self-care Behaviour Scale (EHFScBs), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were completed by self-report before the intervention. The control group received only the routine training of the clinic, while the face-to-face training group received self-care training in four one-hour group sessions, one day apart. The virtual group received the same amount of education in the form of educational clips, and two months after the intervention, the questionnaires were completed. Chi-square tests, Fisher's exact test, paired t-test, and one-way analysis of variance were used to analyze the data. Results: The results pointed out that before the intervention, there was no statistically significant difference between the demographic variables, self-care, and quality of life of patients in the three groups (P&gt; 0.05). After the intervention, no statistically significant difference was observed between the virtual and face-to-face training groups in terms of self-care and quality of life (P&gt;0.05). Nonetheless, self-care and quality of life were improved in these two groups compared to the control group (P˂0.05). Conclusion: Both virtual and face-to-face training methods had the same effect on self-care and quality of life. Virtual training is a great alternative to face-to-face training in the absence of necessary conditions.

Investigating the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients.

Self-care behaviors, which have a vital role in the management of heart failure disease, are influenced by several factors that are of paramount importance. This study aimed to determine the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients. This descriptive-analytical study was conducted from July to September 2021 on 203 patients with heart failure. Samples were selected by convenience sampling method from six centers in Ahvaz city. Data were collected using a clinical-demographic information questionnaire, the European Heart Failure Self-care Behavior Scale (EHFScBs), the Multidimensional Scale of Perceived Social Support (MSPSS), the 12-Item Short Form Health Survey (SF-12), and Paloutzian and Ellison's Spiritual Well-being Scale. Data analysis was performed with SPSS 16 using descriptive and analytical statistical methods including Pearson's correlation coefficient, regression analysis, independent t-test, and analysis of variance. The mean and standard deviation of the age of the female and male participants were 63.54 ± 14.03 and 62.34 ± 13.79, respectively. The majority of the participants (54.2%) were female, had primary education (23.2%), and were married (82.8%). Statistically significant relationships were observed between perceived social support and self-care (r = -0.22, P < 0.01), between spiritual health and self-care (r = -0.39, P < 0.01), and between the quality of life and self-care (r = 0.62, P < 0.01). However, no such relationship was found between demographic characteristics and self-care. Considering the predictive role of spiritual health, social support, and quality of life in self-care behaviors, it is necessary for planners to pay special attention to these factors when designing educational-supportive programs for these patients.

Effect of Daily Activity Record-Based Self-monitoring Intervention on the Perception of Physical Sensations in Patients With Chronic Heart Failure: A Randomized Controlled Trial.

To prevent rehospitalization for heart failure (HF), patients need to be able to perceive physical changes that occur at the onset of HF exacerbation and seek early help. The aim of this study was to evaluate the effect of a self-monitoring intervention on patients' perceptions of physical sensations during daily activities in the context of HF via a randomized controlled trial. Participants (N = 70) were randomly assigned to the intervention (received daily activity record-based self-monitoring intervention support; group A) or control (only explained the measured results from the records; group B) group. Group A reflected on and described the physical sensations in their daily activities within 1 month after discharge. Outcome measures were assessed at 1 month after the intervention using the European Heart Failure Self-care Behavior Scale, Evaluation Scale for Self-Monitoring by patients with Heart Failure, clinical events, physical activity, and sleep. There was no significant difference in the change in the "asking for help" subscale score of the European Heart Failure Self-care Behavior Scale between the groups (+0.7 vs +0.4 points, P = .716). Group A had improved score on the self-monitoring subscale related to "concern about how movements affect body" from baseline (from 12.7 to 14.0 points, P = .026). There was no significant effect of self-monitoring intervention support on the first rehospitalization related to HF and all-cause death (log-rank χ2 = 0.432, P = .511). A significant difference in moderate-intensity physical activity between the groups was observed (+4.6 vs -0.5 minutes, P = .029). A focused strategy that enables patients to perceive their physical sensations and promotes early help-seeking behavior is needed.

Impact of qualified nursing education on self-care and disease knowledge in heart failure patients

Abstract Purpose Guidelines on management of heart failure patients support intensive patient education on self-care. To evaluate the short and long-term impact of a structured education by a qualified heart failure nurse on patient´s self-care and disease knowledge. Methods 131 patients (66±12 years) hospitalized for heart failure participated in a structured one hour education program by a heart failure nurse. Patients completed a questionnaire consisting of 15 questions, nine of the European Heart Failure Self-Care Behaviour Scale (EHFScB-9) and additionally six questions on the patient´s disease knowledge 1 day before, 6 months and 12 months after the education course. Possible responses ranged from 1 (complete agreement) to 5 (complete disagreement). Clinical events during the 12 months follow-up period were determined. Factors predicting with potential impact on the teaching effect were evaluated. Seven patients refused further participation during follow-up, 13 patients were lost during follow-up, and one patient was excluded from the study due to progressive dementia. Results Nine patients died during the study and 33 patients had recurrent hospitalization for heart failure. EHFScB-9 scale improved from 24.0±7.2 at baseline to 17.0±7.4 (p&amp;lt;0.001) at 6 months, and 17.2±6.1 (p&amp;lt;0.001 vs. baseline) after 12 months. Concerning the disease knowledge score, it improved from 17.9±5.3 at baseline to 12.1±4.3 (p&amp;lt;0.05) at 6 months follow-up, and to 12.0±5.5 (p&amp;lt;0.05) at 12 months after education. Scores to individual questions prior to education ranged from 1.2±0.8 on adherence to the medication protocol to 2.7±1.4 on everyday weighting habits. Greatest improvement after education were obtained on reaction to weight gains (-1.9±1.3), daily weight control (-1.6±1.4) and knowledge on the reason of patient’s heart failure (-1.6±1.2). The NYHA-classification improved from 2.8±0.8 before teaching to 2.2±0.7 (p&amp;lt;0.001) at 12-months follow-up. No predictor of an insufficient teaching effect could be defined. Patients with a clinical event (death, recurrent hospitalization) had a combined EHFScB-9 and disease knowledge score of 32.6±8.1vs. 28.9±9.9 in those patients without a clinical event. Patients with more than one hospitalization due to acute decompensated heart failure during the follow-up period express insignificant improvement of the combined EHFScB-9 and disease knowledge score immediately after the education session. Conclusions A qualified nurse education program improves self-care behaviour and patient´s disease knowledge with a persisting effect at 6 and 12 months follow-up. There are no patient characteristics which preclude the implementation of an educational session.

Effect of telemedicine on self-care in heart failure patients: insights from the iCOR randomised controlled trial

Abstract Background/introduction Poor self-care in heart failure (HF) patients is well recognised to lead to a worse prognosis, through an increased risk of readmissions and mortality. In this regard, the integration of eHealth-based telemonitoring and tele-intervention tools into integrated HF-care programmes could help to improve the self-care of these patients. Nevertheless, the current evidence regarding the impact of eHealth solutions on the self-care of HF patients is scarce. Purpose To evaluate the effect of telemedicine (TM) on self-care behaviour in patients with HF after hospital admission compared to usual care (UC). Methods We designed a post-hoc analysis of the "Insuficiència Cardíaca Optimització Remota" (iCOR) study focussing on self-care. iCOR was a randomised, controlled, single-centre proof-of-concept clinical trial, designed to evaluate the efficacy to adding a eHealth-solution to an existing specialised, comprehensive, multidisciplinary, nurse-based, hospital/primary care integrated HF management programme. Participants were randomised to TM or UC after hospital discharge ("vulnerable-phase") and were followed for 6 months. The primary study endpoint of the current analysis was the delta change of self-care after 6 months of follow-up, assessed using European Heart Failure Self-care Behaviour Scale-12 item (EHFScBS-12 item, lower scores meaning better self-care). To assess the change in self-care between the 2 groups, a repeated-measures ANOVA analysis was performed, adjusted for baseline self-care. Results 178 patients were analysed (81 TM vs 97 UC). The median age of the patients was 74±11 years, 41% were female and the median ejection fraction was 47±17%. Self-care at baseline had a median score of 21.6±10.5 points. As shown in Figure 1, there were no differences in baseline values of self-care between the two comparison groups (21.9±11 TM vs 21.5±11 UC, p-value &amp;gt; 0.05). Both groups experienced an improvement in self-care over time (p-value 0.002 for time effect). However, patients in the TM group experienced greater improvement (from 21.9±11 to 14±0.7 mean Delta change = -7.9±11) than in the UC (21.3±10.5 to 19±0.7, mean delta change = -2.2±10.4, p-value &amp;lt;0.001 in inter-groups comparison) (Figure 1). We designed several multivariate linear regression models exploring the determinants of self-care at baseline and the determinants of change in self-care over time. As shown in Table 1, baseline self-care and randomisation arm were the only independent predictors of improvement of self-care over time. Conclusions Integration of TM into HF care programs can contribute to further improve self-care and thus empowerment in the HF-management.Self-care status changeDeterminants of self-care

Abstract 13344: Differential Impact of Self-Care Behaviour on Mortality Between Patients With Stable and Recent Worsening Chronic Heart Failure

Backgrounds: Although self-care is crucial to maintain health and recommended in the guidelines in patients with chronic heart failure (CHF), its prognostic significance is controversial. We hypothesized that self-care is more effective in vulnerable patients with recent hospitalization due to worsening HF (WHF). The aim of this study was to investigate the prognostic significance of self-care behaviour on mortality between patients with stable and recent worsening CHF. Methods: We prospectively examined consecutive 1,873 CHF patients from a Japanese multicenter registry and assessed the European Heart Failure Self-care Behaviour Scale (EHFScBS) at enrollment. The patients were divided into inpatient due to WHF (WHF group) and outpatient stable CHF (stable CHF group). The optimal EHFScBS was defined as more than 70 based on previous reports. The primary outcome was all-cause death. Results: Of studied patients (1,102 male, mean age 72 ± 13 years), 625 (33%) and 1,165 (67%) were classified into WHF and stable CHF groups, respectively. During a median follow-up period of 427 (IQR 273 - 642) days, the primary outcome occurred in 50 patients. In stable CHF group, there was no significant difference on primary outcome between optimal and suboptimal EHFScBS (P = 0.65) (Figure A). On the other hand, patients with suboptimal EHFScBS showed a higher incidence of death than those with optimal score in WHF group (P = 0.01) (Figure B). In WHF group, Cox regressions showed that the EHFScBS score was independently associated with mortality (HR 0.51, 95% CI 0.26-0.99) adjusted for significant covariates including hemoglobin, estimated glomerular filtration rate, serum sodium, log NT-proBNP, and the Meta-Analysis Global Group in Chronic Heart Failure risk score. Conclusions: In patients with recent worsening, not stable CHF, the EHFScBS was associated with subsequent mortality, indicating that the self-care education might be more effective for patients with recent worsening CHF.

Translation, Cross-Cultural Adaptation, and Psychometric Evaluation of the Third Version of the Atlanta Heart Failure Knowledge Test.

Background and Purpose: This study is aimed at translating the third version of the Atlanta Heart Failure Knowledge Test (AHFKTv3) into the Persian language and evaluating its psychometric properties. Methods: In this methodological study, the AHFKTv3 was translated into Persian and its face, content, construct validity, and reliability were assessed. Results: The content validity of AHFKTv3 items was >0.78 and the validity of the instrument was 0.96. The standardized factor loading value of all items, except for item 16, was >0.3. The scores of the AHFKTv3 and European Heart Failure Self-Care Behavior Scale had a significant correlation with each other (p < .001). The AHFKTv3 score had a significant relationship with the educational level. The Kuder-Richardson Formula 20 coefficient was 0.908. Conclusion: The Persian AHFKTv3 is a valid and reliable instrument for assessing HF-related knowledge; therefore, it can be used in nursing practice to identify and address the deficits aiming for better patient care and in research to evaluate treatment and healthcare programs.

Excluding items on salt and fluid restriction from the European Heart Failure Self-care Behaviour Scale - a confirmatory factor analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Self-care is an important component in heart failure (HF) care, and worse, self-care is an independent predictor of mortality, HF hospitalization, and quality of life. The European Heart Failure Self-care Behaviour scale (EHFScB-9) is a validated scale with a nine-item scale and two subscales (autonomy-based adherence and consulting behavior). The items in the EHFScB-9 are based on evidence and consensus. However, in recent years two items regarding salt and fluid restriction have been questioned due to the lack of evidence on their effects. Aim The aim of the study was to evaluate the factor structure of the EHFScB-9 when items on fluid- (item 5) and salt restriction (item 7) were excluded. Method Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the different models of EHFScB-9. Since the item responses of the EHFScB-9 are ordinal, the recommended estimation Weighted Least Squares with Means and Variances (WLSMV) was used. The WLSMV is based on polychoric correlations. The fit indices and recommended cut-off used to support model fit were: the root mean square error of approximation (RMSEA) (≤0.06), Comparative Fit Indices (≥0.95), and Tucker Lewis Index (&amp;gt;0.95). Reliability was evaluated by composite reliability. Results A total of 605 patients were included (mean age 66.9 years (SD=11.7), 71% (n=430) males). All response options were used, but a floor effect was evident for all items (i.e., extreme scores &amp;gt; 15%). The missing values for the items ranged from 2.0 to 2.6%. A total of 10 patients had missing values on all items of the EHFScB-9 and were not included in the CFA. The original two-factor 9-item version (Model 1 in table 1) presented good model fit in all fit indices, including RMSEA: 0.058 (90% confidence interval 0.043-0.073) (Table 1) and reliability of 0.678 in factor 1 "Adherence to regimen" and 0.878 in factor 2 "Consulting behavior". The RMSEA only slightly increased to 0.62 when the items on fluid- (item 5) and salt restriction (item 7) were both excluded (Model 1.2). The model presenting the best model fit was the model where item 5 (fluid restriction) was excluded from the model (RMSEA 0.047, 90% confidence interval 0.029-0.066) (Model 1.3 in the table). As expected, the reliability decreased in factor 1 ("Adherence to regimen") as the number of items was reduced. Conclusion Considering the clinical evidence and the model fit indices, both item 5 and item 7 can be excluded from the EHFScB. As expected, when reducing the number of items, the reliability decreases in factor 1 ("Adherence to regimen"). Nevertheless, the results open for an opportunity to exclude self-care items with less evidence from the EHFScB. The suggested version of the EHFScB needs to be further tested in other contexts, and adding items to factor 1 may be considered.

Validity of Self-reported Self-Care Assessment and Determinants of Self-Care Practices in Older Patients with Heart Failure

Background: Self-care as a disease management strategy in heart failure (HF) is important for the prevention of rehospitalisation, but it is difficult to assess and does not always reflect actual self-care practices. This study aimed to compare self-reported self-care assessments and actual self-care practices in older patients with HF and examine factors influencing self-care performance. Methods: We included 64 patients with HF aged ≥65 years who had been hospitalised and prescribed rehabilitation with stable symptoms between April 2019 and September 2020. We assessed the B-type natriuretic peptide levels and New York Heart Association (NYHA) classification, Short Physical Performance Battery (SPPB), grip strength, and the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We used the European Heart Failure Self-care Behaviour Scale (EHFScBS) to assess self-care behaviour in patients with HF. The patients filled in a self-assessment chart during their stay, which was used to work out the self-care implementation rate. Results: No significant correlation between the self-care implementation rate and the EHFScBS was identified (r= −0.160, p=0.207). Multiple regression analysis of factors associated with the rate of self-care and EHFScBS revealed that age, NYHA classification, SPPB and MoCA-J scores were significantly associated with the rate of self-care; however, no factors were associated with EHFScBS. The results were similar irrespective of the presence or absence of cognitive decline. Conclusion: In older patients with HF, the self-reported assessment of self-care did not reflect actual self-care performance. A reliable self-care behaviour scale needs to be developed.

The AppCare-HF randomized clinical trial: a feasibility study of a novel self-care support mobile app for individuals with chronic heart failure.

We evaluated a self-care intervention with a novel mobile application (app) in chronic heart failure (HF) patients. To facilitate patient-centred care in HF management, we developed a self-care support mobile app to boost HF patients' optimal self-care. We conducted a multicentre, randomized, controlled study evaluating the feasibility of the self-care support mobile app designed for use by HF patients. The app consists of a self-monitoring assistant, education, and automated alerts of possible worsening HF. The intervention group received a tablet personal computer (PC) with the self-care support app installed, and the control group received a HF diary. All patients performed self-monitoring at home for 2 months. Their self-care behaviours were evaluated by the European Heart Failure Self-Care Behaviour Scale. We enrolled 24 outpatients with chronic HF (ages 31-78 years; 6 women, 18 men) who had a history of HF hospitalization. During the 2 month study period, the intervention group (n = 13) showed excellent adherence to the self-monitoring of each vital sign, with a median [interquartile range (IQR)] ratio of self-monitoring adherence for blood pressure, body weight, and body temperature at 100% (92-100%) and for oxygen saturation at 100% (91-100%). At 2 months, the intervention group's self-care behaviour score was significantly improved compared with the control group (n = 11) [median (IQR): 16 (16-22) vs. 28 (20-36), P = 0.02], but the HF Knowledge Scale, the General Self-Efficacy Scale, and the Short Form-8 Health Survey scores did not differ between the groups. The novel mobile app for HF is feasible.

Relationship Between Self-care and Physician-Patient Relations in Patients with Heart Failure

: This study aimed to determine the relationship between self-care and physician-patient relations in patients with Heart Failure (HF). This cross-sectional study was conducted on 200 patients with HF, referring to the outpatient clinics affiliated with Tabriz University of Medical Sciences, Iran. Utilizing a systematic random sampling method, the patients were selected from those who had made intake appointments. The Physician-Patient Relationship Questionnaire and the European Heart Failure Self-Care Behavior scale (EHFScB scale) were used to collect the data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, logistic regression, Student’s t-test, and one-way ANOVA in SPSS (ver. 25). The total score of the self-care behaviors in the patients referring to the outpatient clinics was moderate (31.88 ± 8.66). Also, significant relationships were observed between the scores of self-care behaviors and physician’s gender, patient’s marital status, patient’s education, and between physician-patient relations scores and physician gender (P-value &lt; 0.05). Moreover, physician-patient relations and marital status could predict the patient’s self-care variable by 22% (R2 = 0.221, F = 5.35). The study results revealed that physician-patient relations could explain the self-care behaviors of patients with HF.

Impact of a Nurse-Led Multidisciplinary Heart Failure Clinic in a Low-Resource Setting: Experience in a Latin American Public Healthcare System

BackgroundNurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. MethodsPatients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. ResultsThe questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. ConclusionAn MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.

The association between comorbidities and self-care of heart failure: a cross-sectional study

BackgroundBecause heart failure (HF) is a debilitating chronic cardiac condition and increases with age, most patients with HF experience a broad range of coexisting chronic morbidities. Comorbidities present challenges for patients with HF to successfully perform self-care, but it is unknown what types and number of comorbidities influence HF patients’ self-care. The purpose of this study was to explore whether the number of cardiovascular and non-cardiovascular conditions are associated with HF self-care.MethodsSecondary data analysis was performed with 590 patients with HF. The number of cardiovascular and non-cardiovascular conditions was calculated using the list of conditions in the Charlson Comorbidity Index. Self-care was measured with the European HF self-care behavior scale. Multivariable linear regression was performed to explore the relationship between the types and number of comorbidities and self-care.ResultsUnivariate analysis revealed that a greater number of non-cardiovascular comorbidities was associated with poorer HF self-care(β=-0.103), but not of more cardiovascular comorbidities. In the multivariate analysis, this relationship disappeared after adjusting for covariates. Perceived control and depressive symptoms were associated with HF self-care.ConclusionThe significant relationship between the number of non-cardiovascular comorbidities and HF self-care was not independent of perceived control and depressive symptoms. This result suggests a possible mediating effect of perceived control and depressive symptoms on the relationship between HF self-care and the number and type of comorbidities.

Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study.

Promoting patients' sense of security is among the goals of nursing care within heart failure management. The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status (P < .01) and sense of security (P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.

Relationship between Disease Knowledge and Self-care Adherence among Heart Failure Patients at King Abdulaziz University Hospital

Backgrounds: Heart failure (HF) is a progressive syndrome characterized bycomplicated therapeutic regimens and repeated hospitalizations. HF has turnedinto a global epidemic demonstrating serious mortality and morbidity. This studyaimed to assess the relationship between disease knowledge and self-careadherence among adult HF patients at King Abdulaziz University Hospital (KAUH).Methods: A cross-sectional descriptive correlational design was utilized. Patientswere recruited from outpatient clinic at KAUH in Jeddah, Saudi Arabia. Aconvenience sample of 208 HF patients. The Dutch Heart Failure Knowledge Scale(DHFS) and the European Heart Failure Self-Care Behavior Scale (EHFSCBs) wereused to measure the main study outcomes. Participants were recruited from heartfailure outpatient clinics at KAUH from January 31 – May 17, 2021. Results: 63.9%of participants were male, 49% were over 61 years old, and 30.8% of theparticipants were not educated. 55.8% of the participants had an adequate level ofknowledge about HF disease and 57.2% had a good level of self-care adherence. Themean total HF knowledge score DHFS was 8.58±3.08 out of 15 and the self-careadherence score EHFSCBs was 28.97 ±5.61out of 60. A significant positive moderatecorrelation existed between disease knowledge and self-care adherence.Conclusion: Disease knowledge was adequate in more than half of the participants,and self-care adherence was good. This study has shown a relationship betweendisease knowledge and self-care adherence, which means that a high level of HFknowledge was associated with improved self-care adherence.

Psychometric properties of self-reported measures of self-management for chronic heart failure patients: a systematic review.

To identify and assess the psychometric properties of patient-reported outcome measures (PROMs) of self-management for chronic heart failure (CHF) patients. Eleven databases and two websites were searched from the inception to 1 June 2022. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist was used to assess the methodological quality. The COSMIN criteria were used to rate and summarize the psychometric properties of each PROM. The modified Grading of Recommendation Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. In total, 43 studies reported on the psychometric properties of 11 PROMs. Structural validity and internal consistency were the parameters evaluated most frequently. Limited information was identified on hypotheses testing for construct validity, reliability, criterion validity, and responsiveness. No data regarding measurement error and cross-cultural validity\measurement invariance were achieved. High-quality evidence on psychometric properties was provided for Self-care of Heart Failure Index (SCHFI) v6.2, SCHFI v7.2, and European Heart Failure Self-care Behavior Scale 9-item (EHFScBS-9). Based on the findings from the included studies, SCHFI v6.2, SCHFI v7.2, and EHFScBS-9 could be recommended to evaluate self-management for CHF patients. Further studies are necessary to evaluate more psychometric properties, such as measurement error, cross-cultural validity\measurement invariance, responsiveness, and criterion validity, and carefully evaluate the content validity. PROSPERO CRD42022322290.