European Heart Failure Self-care Behaviour Scale Research Articles

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.

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 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.

Depressive symptoms are mediating the relationship between non-cardiac comorbidities and self-care of heart failure

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure; National Research Foundation of Korea grant funded by the Korea government (MEST) Background Most patients with heart failure (HF) have multiple chronic comorbid conditions. For HF patients with non-cardiac conditions, adhering to recommended self-care regimens can be complicated because recommended regimens across those conditions can even conflict with each other. Our previous study has shown that the significant relationship between non-cardiac comorbidities and HF self-care disappeared after covariates were entered in the regression model. The lack of the direct effect of non-cardiac comorbidity on HF self-care may be due to the effects of a possible mediator. Depressive symptoms are highly prevalent to patients with heart failure and in those with multiple chronic conditions, and negatively affect patients’ adherence to self-care. Therefore, it is possible that depressive symptoms mediate the relationship between non-cardiac comorbidities and self-care. Purpose To examine the mediating effect of depressive symptoms on the relationship between non-cardiac comorbidities and HF self-care in patients with HF. Methods A total of 590 patients with HF (66 years, 41% female, 35% New York Heart Association function class III/IV) were included in this study. The list of non-cardiac conditions was identified from the Charlson Comorbidity Index. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9). Self-care was measured with the 9-item European HF self-care behavior scale (EHFScBS). The EHFScBS scores were standardized ranging from 0-100, with higher scores indicating better self-care. The mediation analysis was conducted using the PROCESS macro program in SPSS (version 3.5) with 5000 bootstrap samples. Results Less than one-third of the patients (30.8%) had clinically significant depressive symptoms (PHQ-9 scores of 10 or greater). On average, patients had one non-cardiac comorbidity. The results of the mediation analysis were presented in the Figure. The total effect of the number of non-cardiac comorbidities on HF self-care was significant, after adjusting for covariates. The direct effect of the number of non-cardiac comorbidities on HF self-care was not significant, while the indirect effect mediated by depressive symptoms was significant. This indicate the mediation of depressive symptoms on the relationship between the number of non-cardiac comorbidities and HF self-care. Conclusion We found that the depressive symptoms are a mechanism linking non-cardiac comorbidities and HF self-care. This result indicates that depressive symptoms is a greater barrier to engaging in HF self-care than the complexity of managing non-cardiac comorbidities. Therefore, clinicians need to assess and manage depressive symptoms to improve HF self-care for HF patients with non-cardiac comorbidities.

Psychometric properties of the Persian version of the European heart failure self-care behavior scale

Abstract Objective To investigate the psychometric properties of the self-care behavior scale in heart failure (HF) patients. The development of self-care behaviors is one of the goals of non-pharmacological care management programs. Methods After translating the European Heart Failure Self-care Behavior scale (EHFScBS), validity was assessed through explanatory factor analysis; additionally, reliability was assessed through Cronbach alpha and test–retest. The samples comprised of 120 HF patients admitted to hospitals in Tehran during 2017–2018. Results The mean age of the samples was 67.3 ± 14.04 years. Fifty-four patients (45%) were female. All items of the scale had an acceptable factor loading. Cronbach alpha coefficient was 0.72. The intra-cluster correlation coefficient (ICC) was 0.69. Conclusions Nurses and clinicians could benefit from the Persian version of HF self-care scale since it would enable them to rapidly assess patients’ self-care behaviors and to evaluate the effectiveness of the HF management.

Factors related to self-care behaviors among hospitalized patients with heart failure in Japan, based on the European Heart Failure Self-Care Behaviour Scale.

[Purpose] The characteristics of heart failure in hospitalized patients with poor self-care behaviors are unknown. We investigated factors associated with self-care behaviors by using the European Heart Failure Self-Care Behaviour Scale (EHFScBS) in heart failure patients based on three comprehensive concepts. [Participants and Methods] This was a cross-sectional single-center study of heart failure patients hospitalized at a tertiary-care hospital. We investigated age, gender, family living together/apart, employment, and the Specific Activity Scale (SAS). A physical therapist provided the EHFScBS one time to determine the patients’ pre-hospital self-care behavior status. The 12 items of the EHFScBS were classified into the following three categories: Maintenance, Monitoring, and Management. [Results] The median age of the 39 consecutive patients was 81 years. A multiple regression analysis revealed that the factors exhibiting significant associations were the SAS score (β=0.504) for Management and age (β=−0.403) for the total EHFScBS score (adjusted by the number of hospitalizations for heart failure). Maintenance and Monitoring were not significantly associated with the survey items. [Conclusion] These data indicate that self-care education for hospitalized patients with heart failure leads to individualized approaches based on characteristics such as age and physical activity capacity.

The types of comorbidities are associated with self-care of heart failure, but not the number of comorbidities

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): RO1HL083176 Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure Background/Introduction: Patients with heart failure (HF) experience cardiac and non-cardiac related comorbid conditions. Such comorbidities create challenges to successful engagement in self-care of HF because patients are asked to simultaneously perform a variety of recommended self-care activities for HF and their comorbid conditions. It is possible that patients with a greater number of comorbid conditions experience more difficulty performing activities of HF self-care compared to those with a smaller number of comorbid conditions. However, it is also possible that types of comorbid conditions are more important factors influencing self-care of HF. Purpose To explore whether self-care of HF is associated with the number of comorbid conditions or types of comorbid conditions. Methods A total of 589 patients with HF (66 years, 41% female, 65% NYHA III/IV) were included in this study. The number of comorbid conditions was measured using the list of the conditions in the Charlson Comorbidity Index. Types of comorbidities were defined as follows: concordant conditions, sharing overall pathophysiologic risk profiles with HF, and discordant conditions, not being directly related to HF. Patients were categorized into 4 groups: HF patients without comorbidities; those with concordant conditions; those with discordant conditions; and those with both concordant and discordant conditions. Self-care was measured with the European HF self-care behavior scale. A multivariate linear regression was performed to explore the relationship of HF self-care with the number and types of comorbid conditions after adjusting for relevant covariates. Results The number of comorbid conditions was not associated with self-care of HF. However, the types of comorbid conditions were related to self-care of HF after controlling for covariates. Compared to HF patients without comorbidities, patients with both concordant and discordant conditions were more likely to have poorer self-care (β=0.155, 95% CI 0.29-4.09). However, levels of self-care in patients having either concordant or discordant conditions were not different from levels in patients having no comorbid conditions. Conclusion: Patients’ adherence to HF self-care was associated with the types of comorbidities, but not the simple count of comorbidities. Patients who had both concordant and discordant conditions were more likely to perform poor self-care of HF compared to those who had either concordant or discordant conditions or no comorbid conditions. It appears that HF patients with both concordant and discordant conditions experience difficulty integrating HF self-care in relation to a variety of conditions.

Child ego state and self-care behavior change in heart failure patients

BackgroundThe psychological characteristics of ego functions interfere with self-care behavior in several diseases. However, the effect of ego functions on self-care behavior after education in heart failure (HF) remains unclear. MethodsSeventy-one HF patients were enrolled. Patients’ scores on the Japanese version of the European Heart Failure Self-care Behaviour Scale (EHFScBS) were measured before and after the HF intervention, and the rate of change was used as an indicator of educational effectiveness. The Tokyo University Egogram New Ver. II was used to assess five types of ego state functions: Critical parent, Nurturing parent, Adult, Free Child, and Adapted Child (AC). ResultsA comparison of the five ego states showed that AC scores were significantly lower than those of the other ego states (p < 0.01). Total EHFScBS scores significantly decreased from 33 (26–39) to 16 (14–20) (p < 0.01) after the HF education, and the median rates of change in EHFScBS was −46.2%. Patients with a lower rate of change in EHFScBS were more likely to have low AC scores, as characterized by a lack of compliance and coordination, and were less likely to receive higher education (all p < 0.05). Even after adjustment for covariates, low AC scores were independently associated with low rate of change in EHFScBS (p < 0.01). ConclusionsEducational behavior change for self-care is less effective in HF patients with an ego state with low AC.

Methodological quality of studies assessing validity and reliability of the European Heart Failure Self-care Behaviour Scale: a systematic review using the COSMIN methodology

The European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology. To identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality. Although the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS.

A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study.

BackgroundHeart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease.ObjectiveThe objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study.MethodsThe development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate.ResultsA systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%.ConclusionsThe need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.

Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study

Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care. Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory-HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year's hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores' relationships with hospitalizations using Spearman's rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample's mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations. The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.

Development and psychometric testing of the European Heart Failure Self-Care behaviour scale caregiver version (EHFScB-C)

BackgroundThe European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist. ObjectiveTo develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients. MethodsThe EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands. ResultsExploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers’ contributions to HF self-care related to medical issues, and caregivers’ contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbach’s alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale. Conclusion and Practice ImplicationsThe EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies.

Patterns of Heart Failure Dyadic Illness Management: The Important Role of Gender.

The ways in which patients with heart failure (HF) and their care partners work together to manage HF are often overlooked. The aim of this study was to identify and compare different patterns of HF dyadic illness management. This was a secondary analysis of data on HF dyads. Heart failure management was measured using patient and care partner versions of the Self-Care of HF Index and European HF Self-care Behavior Scale. Latent class modeling was used to identify patterns of HF dyadic management. The mean age of the 62 patients and their care partners was 59.7 ± 11.8 and 58.1 ± 11.9 years, respectively. A majority of patients (71.0%) had class III/IV HF, and a majority of the couples (95.2%) were married. Two distinct dyadic patterns were observed, 1 collaborative management type (n = 42, 67.7%) and 1 autonomous management type (n = 20, 32.3%). Dyads in the autonomous pattern were mostly female patients with male care partners; patients in this pattern also were more anxious and depressed, and reported worse relationship quality compared with collaborative dyads. There is an engendered spectrum of collaboration in how HF patient-care partner dyads work together to manage HF that needs to be considered in clinical care and research.

Cognitive and self-care changes in patients with heart failure in the Amazon Region

Heart failure is characterized as the lack of blood pumping capacity performed by the heart, which is considered a public health problem worldwide. Due to HF, the individual can develop clinical aspects that impact cognitive function and, consequently, self-care. Therefore, this study aimed to investigate cognitive changes and self-care in patients affected by HF and compare it with the cognitive and self-care changes of healthy participants. This is a quantitative, epidemiological, cross-sectional case-control study carried out at an institution in the city of Belém, Pará, Brazil. The following tests were used for data collection: Montreal Cognitive Assessment, Digit Symbol Substitution Test, European Heart Failure Self-care Behavior Scale (EHFScBS). Data were tabulated in Microsoft Excel 2010 and statistically treated by Epi Info version 3.5.2 with a 5% significance level and considering a 95% confidence interval in all analyzes. It was observed that patients with HF have slightly better self-care compared to patients without HF with scores obtained by EHFScBS equal to 29.7 ± 6.9 and 31.8 ± 8.2, respectively. Additionally, patients with HF showed impairments in the three cognitive domains, and women with HF demonstrated greater cognitive impairment compared to the other participants. The present study provides data to help build new approaches to interventions by the multidisciplinary team to promote better self-care and avoid cognitive impairments in patients with HF.

Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale

The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide. The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF. To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency. Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable. Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self-care: impact on outcomes.

To evaluate the abilities to perform essential tasks for heart failure (HF) self-management in elderly patients, and its influence on post-discharge prognosis. Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self-administered questionnaire European HF Self-care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self-care on 1-year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1years. On average, patients could perform 2.9±1.6 of self-care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self-care education had slight better performance (3.2±1.6 vs 2.8±1.6, P<0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r=-0.135; P=0.006). One-year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P=0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32-1.03; and HR 0.40; 95% CI 0.21-0.77, respectively], without differences in readmissions. Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self-care. Self-perception of care was poorly correlated with real ability, and poor self-care ability was associated with higher 1-year mortality risk.

Gender differences in prognostic relevance of self-care behaviors on mortality and hospitalization in patients with heart failure – A report from the CHART-2 Study

BackgroundSelf-care behaviors (ScB) are associated with symptoms and outcomes in patients with heart failure (HF). However, little is known about gender differences in the prognostic relevance of ScB in HF patients. MethodsWe examined gender differences in ScB of HF patients regarding its prognostic associations with mortality and HF hospitalization with a reference to ScB dimensions. The European Heart Failure Self-Care Behavior Scale (EHFScBS) was used to evaluate ScB in 2233 patients with Stage C/D HF in the CHART-2 Study. ResultsMale patients (n=1583) were younger (71 vs. 73 yrs) and had lower ScB (median 33 vs. 31) (all p<0.001) than females (n=650). During the median follow-up of 2.57 years, patients with high ScB (score 12–32, n=1090), as compared with low ScB patients (score 33–60, n=1143), had significantly increased all-cause mortality in males [adjusted hazard ratio (aHR) 1.44, p=0.02] but not in females (aHR 0.80, p=0.40) (p for interaction 0.02), while ScB was not significantly associated with incidence of HF hospitalization in both genders. Among the 3 dimensions in EHFScBS, complying with regimen was associated with decreased mortality in females, but not in males (p for interaction 0.003), while asking for help was related with increased incidence of HF hospitalization in males (aHR 1.34, p=0.072) but not in females (aHR 0.98, p=0.931) (p for interaction 0.048). ConclusionsThere were gender differences in the prognostic relevance of self-care with mortality and incidence of HF hospitalization, suggesting that self-care should be implemented considering gender differences to improve prognosis.

Changes in Heart Failure Self-care Behaviors and Intrathoracic Impedance over 6 Months.

Background Poor heart failure (HF) self-care has been shown by others to be associated with lung fluid accumulation measured by intrathoracic impedance. No studies, however, have examined how HF self-care is associated with intrathoracic impedance over time. Objective Examine the association of self-care behaviors and intrathoracic impedance using Medtronic Optivol Index threshold crossings as a marker of pulmonary congestion over 6 months. Method Patients with symptomatic HF and a Medtronic Optivol-enabled device had two 90 day periods of impedance data collected that corresponded with two waves of data collection on HF self-care (measured with the European HF Self-care Behavior Scale (EHFScBS)), as well as sociodemographic and clinical data. Changes in Optivol threshold crossings data (categorized as more frequent (31%) vs. fewer (69%) episodes of congestion) and self-care were calculated between the two phases of measurement. Multivariate logistic regression was use to quantify the likelihood of the self-care behaviors predicting an increase in threshold crossing over the 6 months. Results Participants (n=47) were mostly male (57%), on average 62 years old with predominantly non-ischemic (81%), NYHA Class III/IV HF (64%). Adjusting for sociodemographic and clinical factors, improvement in HF self-care care over time was associated significantly with lower odds of having more frequent threshold crossings over time (odds ratio=0.74; 95% confidence interval, 0.55–0.99; p=0.039). Conclusion Positive changes in HF self-care over time may decrease the odds of having more fluid accumulation or pulmonary congestion events. Our study supports self-care as an essential aspect of HF self-management. Furthermore, longitudinal and experimental studies are needed to examine the temporal and causal relationship between objective markers of HF pathophysiology and self-care behaviors.

Evaluation of self care behaviours, medication and dietary compliance of patients with heart failure

In this study, it was aimed to evaluate the self-care behaviors, dietary and medication compliance of patients with heart failure.The study was conducted as a cross-sectional sampling study between April and August 2016. After identifying the clinical diagnosis and treatment, 120 patients who were diagnosed with HF were included in the study. Data were obtained by using personal information form, Turkish versions of the European Heart Failure Self-care Behavior Scale (EHFScBS), Beliefs about Medication Compliance Scale and Beliefs about Dietary Compliance Scale for patients with HF. The mean score on EHFSc BS was found to be 31.20± 8.05. Benefit and barrier subscale mean scores were found to be 26.11 ± 4.23 and 13.09 ± 3.5 for dietary compliance and 20.44 ± 2.7 and 22.36 ± 3.8 for medication compliance, respectively. According to the results of the study ıt was found that there was a moderate relationship between self-care behaviors and dietary compliance (r=0,538,p&lt;0,05) benefits and medication compliance (r=0,420, p&lt;0,05 ) benefits. Keywords: The European Heart Failure self care scale; medication compliance; dietary compliance; heart failure.

Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model.

While comprehensive evidence exists regarding negative effects of depression on self-care behaviours in patients with chronic heart failure (CHF), the relation between anxiety and self-care behaviours in patients with CHF is not clear. The aim of this study was to analyse the interactions between anxiety, depression and self-care behaviours in patients with CHF. The self-care behaviour of CHF outpatients was measured using the European Heart Failure Self-care Behaviour Scale (EHFScBS). The Patient Health Questionnaire (PHQ) was used to assess anxiety, the PHQ-9 was used to measure depression severity. Differences between patients with and without anxiety were assessed with the respective tests. Associations between anxiety, self-care and other predictors were analysed using linear regressions. Of the 308 participating patients, 35 (11.4%) fulfilled the PHQ criteria for an anxiety disorder. These patients took antidepressants more frequently (11.8% versus 2.3%, p = .02), had had more contacts with their general practitioner within the last year (11.8 ± 16.1 versus 6.7 ± 8.6, p = .02), and had a higher PHQ-9 depression score (12.9 ± 5.7 versus 6.5 ± 4.7, p < .01) than patients without anxiety disorder. Anxiety and self-care were negatively associated (ß = -0.144, r2 = 0.021, p = 0.015). The explanation of variance was augmented in a multivariate regression with the predictors age, sex, education, living with a partner, and New York Heart Association (NYHA) class ( r2 = 0.098) when anxiety was added ( r2 = 0.112). Depression further increased the explanation of variance (ß = -0.161, r2 = 0.131, p = 0.019). Anxiety is negatively associated with self-care behaviour in patients with CHF. However, this effect disappears behind the stronger influence of depression on self-care. The consideration of mental comorbidities in patients with CHF is important.