European Heart Failure Self-care Behaviour Research Articles

Non-invasive home telemonitoring system for heart failure patients: A randomized clinical trial

Introduction The low quality of life in heart failure patients is related to low self-care and treatment adherence. Consequently, innovative strategies are needed to improve them. The objective of this work is to determine the effectiveness of the use of a home telemonitoring system to improve the self-care and treatment adherence of heart failure patients. Methods A randomized clinical trial that compares the efficacy of a home telemonitoring system –intervention group versus usual care control group – among heart failure outpatients over a 90-day monitoring period was carried out. The home telemonitoring system consists of an application that collects measurements of different parameters on a daily basis and provides health education to patients. The home telemonitoring system processes data gathered and generates an alert if a risky situation arises. The outcomes observed were significant changes in patients’ self-care (European Heart Failure Self-care Behaviour Scale), treatment adherence (Morisky Modified Scale) and re-hospitalizations over the follow-up period. Results 104 heart failure patients were screened; 40 met the inclusion criteria; only 30 completed the study. After the follow-up, intragroup analysis of the control group indicated a decrease in treatment adherence (p = 0.02). The mean European Heart Failure Self-care Behaviour Scale overall score indicated an improved self-care in the intervention group patients (p = 0.03) and a worsened self-care in the control group (p = 0.04) with a p value of 0.004 in the intergroup analysis. Thanks to the home telemonitoring system alerts, two re-hospitalizations were avoided. Discussion This study demonstrated that the proposed home telemonitoring system improves patient self-care when compared to usual care and has the potential to avoid re-hospitalizations, even considering patients with low literacy levels. Trial Registration: Home Telemonitoring System for Patients with Heart Failure. clinicaltrials.gov Identifier: NCT04071093

Social Support and Self- Care Behaviour among Heart Failure Patients

Heart failure is a disease that could cause a significant medical burden. This study aims to determine the relationship between social support and self-care behaviour among heart failure patients. Thirty patients from a Clinical Training Centre participated in this cross-sectional study. Instruments used in the study were the Multidimensional Scale of Perceived Social Support (MSPSS) and The European Heart Failure Self-care Behaviour Scale-9 item (EHFSCBC). The results showed that there was a relationship between social support and self-care behaviour (r=0.40, p<0.05). Awareness of the impact of social support on self-care behaviour is vital for heart failure patients and their families.Keywords: Heart failure, social support, self-care behavioureISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v4i12.1906

Cross-Cultural Adaptation and Reliability of the French-Canadian Version of the European Heart Failure Self-Care Behaviour Scale-9.

The purposes of this methodological study were to adapt the European Heart Failure Self-care Behaviour Scale-9 to the French-Canadian population and to evaluate its reliability. The adaptation process consisted of translation, back-translation, evaluation by an expert committee, and pretesting. Reliability was evaluated with stability criteria (test-retest) and internal consistency. Pretesting led to testing of two response formats: 5-point Likert scale and the frequency scale. Both demonstrated good levels of agreement between the test-retest, although the values were higher with the frequency format. The Cronbach's alpha coefficients ranged from 0.71 to 0.78 (Likert scale) and 0.70 to 0.83 (frequency scale). The French-Canadian version of the EHFScB-9, in both formats, demonstrated good evidence of reliability.

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.

Adherence to diet and medication and the associated factors among patient with chronic heart failure in a multi-ethnic society

ObjectiveTo investigate diet adherence, medication adherence and self-care behaviour among patients with chronic heart failure (CHF) in a multi-ethnic society and identify the significant factors associated with their diet and medication adherence. MethodsA cross-sectional descriptive correlational study was conducted with a convenience sample of 107 patients with CHF recruited from two cardiology wards of a public tertiary hospital in Singapore. Study variables were measured using the Dietary Sodium Restriction Questionnaire, the Medication Adherence Rating Scale-5 items and the European Heart Failure Self-care Behaviour Scale-12 items. ResultsOur sample reported positive attitudes towards diet adherence, poor self-care behaviour, and good medication adherence. The multiple linear regression results indicated that lower income, Chinese ethnicity, diabetic complications, current smoking, lower New York Heart Association classification I and II, and poorer self-care behaviour predicted poorer diet adherence. In addition, absence of hypertension, having non-myocardial infarction as a cause of CHF, and moderately diminished ejection fraction were identified as significant predictors of poorer medication adherence. ConclusionThe findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication.

The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure: A secondary analysis of a randomised controlled trial

BackgroundPatients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. ObjectivesTo investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DesignA secondary analysis of data collected in a pilot randomized controlled study. Setting50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden. MethodsPatients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. ResultsNo significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). ConclusionImprovement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.

4035Impact of qualified nursing education on the care of heart failure patients in a regional physician network

Abstract Background The ESC guidelines on management of patients with heart failure support a multidisciplinary management program including intensive patient teaching and follow-up care. However, adequate information of patients with heart failure on their disease by the treating physician is often limited due to time restrictions. Aim This study evaluated the short and long-term impact of a structured education program by a qualified heart failure nurse on the patient's understanding of his disease and adherence to therapy. Methods 95 consecutive patients (67 male, mean age 66±11 years) hospitalized for heart failure symptoms were included in a structured education program. Each patient underwent an individual one hour teaching program by a qualified heart failure nurse who used structed teaching material. Patients were requested to respond to a questionnaire consisting of 15 questions 1 day before and 1 day after the teaching course as well as at a 6 months follow-up. The questionnaire included the nine questions of the European Heart Failure Self-Care Behaviour Scale (EHFSCB9-Scale) as well as 6 questions on the patient's knowledge about his disease. For each question the patient had to respond to a scale ranging from 1 point (complete disagreement) to 5 points (complete agreement). 6 months follow-up data were obtained by physicians providing the outpatients care and implemented into a password protected software offering all patient data within the local network consisting of the hospital and 4 regional outpatient cardiologists. Results Total self-care behavior and disease knowledge score improved from 48.3±10.1 points before teaching to 64.0±9.9 points after teaching (p&lt;0.001). Before teaching there were significant differences in the scores of individual questions ranging from 2.40±1.36 points on understanding of the own disease to 4.71±0.80 points on complete adherence to the medication protocol. After teaching there was a more homogenous score levels. Greatest gains on individual question scores could be obtained on “the patients understanding of the causes of his disease” (1.52±1.38 points), “the feeling of being completely informed about the disease” (1.44±1.23 points) and “daily weight control” (1.73±1.58 points). At 6-months follow-up total self-care behavior and disease knowledge score was 59.2±13.2 points (p=0.231 to immediately after teaching) in the 67% of patients with complete follow-up. In a logistic regression analyses no parameter could be defined which predicted a low knowledge score before teaching or an insufficient teaching effect. Conclusions A qualified nurse education program significantly improves self-care behavior and disease knowledge. The effect persists at 6 months follow-up. Improvements can be obtained in particular with regards to patients understanding of his disease causes and daily weight control. There are no patient characteristics which obviate the need for teaching or predict a low teaching effect. Acknowledgement/Funding Deutsche Stiftung für chronisch Kranke

Relationship between self-care behaviors and quality of life in patients with heart failure

BackgroundIt has been generally agreed that cardiac failure is one of the common and devastating diseases due to its morbidity, mortality and rates of disability. Moreover, it has negative impacts on quality of life among sufferers. Meanwhile, improving quality of life among heart failure patients is essential. It can be suggested that people with self-care ability have a better quality of life. However, this issue may be affected by some cultural issues. Regarding a paucity of information on this aspect in Iran, this study aims to explore the relationship between self-care behaviors and quality of life in patients with heart failure. MethodsThis study is carried out using a descriptive - analytical method. The sample size consists of 77 patients who consented to participate in the study and had ejection fraction <40%. The tools were demographic checklist, European heart failure self-care behavior scale, and SF-36 quality of life questionnaire. Data was gathered from the heart center of Imam Ali in Kermanshah-Iran. Data analysis was done using independent t-test, Mann Whitney, ANOVA, and Kruskal-Wallis tests by SPSS-24 software. FindingsThe study sample was 77 participants, of which 45 were female and 51 lived in an urban area. The mean of self-care score was 39.42 ± 7.04, and most of the patients (67.5%) were in moderate level. The mean and SD of quality of life was estimated as 38.45 ± 17.28. The spearman correlation test showed no correlation between self-care and quality of life. However there was a correlation between marital status and self-care ability, in which it shows the higher scores in unmarried people (K2 = 7.75, P = 0.021), and the results indicated better quality of life in male (t = 2.68, P = 0.009), educated patients at the level of university (F = 7.60, P < 0.001), free job (F = 6.21, P < 0.001) and lived in the urban area (Z = 2.05, P = 0.04). ConclusionIn this study, there is no correlation between self-care behaviors and quality of life in which, this may be attributed to Iranian cultures and perspectives such as valuing live with the children and importance of their attention to elderly patients, which demanded more studies.

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.

Socio-clinical variables affecting the level of self-care in elderly patients with heart failure.

Promoting self-care is the cornerstone of heart failure management. The number of hospitalizations and unscheduled visits could be reduced in elderly patients with heart failure by the patients' active involvement in self-care. The aim of this study was to measure the level of self-care in elderly patients with heart failure, to examine the influence of socio-clinical variables on the level of self-care, and identify the socio-clinical variables that are predictors of self-care. The study included 100 heart failure patients (48 female, 52 male) aged between 60 and 88 years, treated at the Oleśno Health Care Center (Poland). The European Heart Failure Self-care Behavior Scale-9 and Mini-Mental State Examination were used. The total classic European Heart Failure Self-care Behavior Scale-9 score was 22.76 points (standard deviation=8.49), and the standardised European Heart Failure Self-care Behavior Scale-9 score was 61.78 (standard deviation=23.59). Patients who were in a relationship, did not take digoxin or diuretics, were in New York Heart Association classes I and II, and had normal scores or cognitive impairment in the Mini-Mental State Examination, had significantly higher levels of self-care. Self-care was also correlated with patient age (rs=-0.36, p<0.001) and left ventricle ejection fraction (rs=0.23, p=0.019). Linear regression analysis demonstrated that only the New York Heart Association class has a significant impact on European Heart Failure Self-care Behavior Scale-9 scores. Compared to classes I and II, New York Heart Association class IV decreases the standardised European Heart Failure Self-care Behavior Scale-9 score by a mean of 23.60 points. Intensified self-care education should be provided to patients living alone, taking digoxin and diuretics, suffering from moderate dementia, and classified in New York Heart Association class IV. These patients may require specific educational strategies to gain the knowledge required for effective self-care.

Effectiveness of continuous-care model on self-care in patients with heart failure: application of line follow-up.

Self-care behaviours are one of the most important determinant factors in the prognosis of heart failure, which can improve the symptoms of the disease, the performance and the reduction of mortality in these patients. The aim of this study was to determine the effectiveness of continuous-care pattern on self-care in heart failure patients admitted to Shahid Chamran Hospital in Isfahan. This quasi-experimental study is implemented on 72 patients with heart failure who are admitted to Shahid Chamran Hospital in Isfahan. The patients are randomly assigned to the experimental and control groups (36 patients in each group). For a period of three months, a continuous-care model is performed, and then, the self-care score of patients with heart failure is compared in both groups at baseline and follow-up assessment. The required data were gathered using a demographic questionnaire and a European Heart Failure Self-Care Behavior (EHFSCB). Regarding the implementation of the continuous-care model, the results showed that the mean self-care score before the implementation of the continuous-care model was 28.2±5.02 in the experimental group and 29.5±3.7 in the control group, which was not statistically significant (p=0.22). However, after implementing continuous-care model, the mean self-care score of the experimental group was 51.4.4±2.8 as compared to the control group (30.8±3.2) (p<0.001). Based on the findings of this study, it can be concluded that the implementation of this care model can lead to an increase in self-care score in patients with chronic heart failure.

Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey.

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

Psychometric Evaluation of the Persian eHealth Literacy Scale (eHEALS) Among Elder Iranians With Heart Failure.

The purpose of the present study was to examine the psychometric properties of the eHealth Literacy Scale (eHEALS) using classical test theory and modern test theory among elderly Iranian individuals with heart failure (HF). Individuals with objectively verified HF (n = 388, 234 males, mean age = 68.9 ± 3.4) completed the (i) eHEALS, (ii) Hospital Anxiety and Depression Scale, (iii) Short Form 12, (iv) 9-item European Heart Failure Self-Care Behavior Scale, and (v) 5-item Medication Adherence Report Scale. Two types of analyses were carried out to evaluate the factorial structure of the eHEALS: (i) confirmatory factor analysis (CFA) in classical test theory and (ii) Rasch analysis in modern test theory. A regression model was constructed to examine the associations between eHEALS and other instruments. CFA supported the one-factor structure of the eHEALS with significant factor loadings for all items. Rasch analysis also supported the unidimensionality of the eHEALS with item fit statistics ranging between 0.5 and 1.5. The eHEALS was significantly associated with all the external criteria. The eHEALS is suitable for health-care providers to assess eHealth literacy for individuals with HF.

Knowledge about heart failure and self-care persists following outpatient programme- a prospective cohort study from the Faroe Islands

ABSTRACT Objectives: Longer life expectancies imply increased prevalence of heart failure. Blittle is known about the maintenance of disease specific knowledge following patient education. Our aim was to investigate if self-care and heart failure knowledge persists at 9 month follow up among patients with heart failure after an outpatient programme in the Faroe Islands. Methods: A prospective cohort study with patients recently diagnosed with heart failure were recruited and evaluated by questionnaire at baseline, after 3 and 9 months using The European Heart Failure Self-Care Behaviour Scale and the Dutch Heart Failure Knowledge Scale. Clinical and demographic information was collected. Results: Seven (15%) women and 40 (85%) men with heart failure and NYHA > 2 were included. There was an overall improvement in patients’ self-care from baseline 25 (8) to 3 months 15 (5) and to 9 months (16 (45); both p < 0.001). Mean knowledge score 10 (3) improved to 13 (2) at 3 months and 12 (2) at 9 months (both p < 0.001). Conclusions: Disease specific patient education is applicable to heart failure patients, which can produce persistent improvements in self-care and knowledge after multidisciplinary outpatient programme. Practice Implications: Multidisciplinary outpatient programmes are beneficial for patients with heart failure and alters disease specific knowledge and self-care.

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.

Psychometric Validation of the Korean Version of the 9-Item European Heart Failure Self-Care Behaviour Scale.

Heart failure (HF) is the most common cause of frequent hospitalizations and high mortality. Active engagement in self-care behaviors is an essential component of HF disease management. Although the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9) as a commonly used instrument has been validated in different languages, there is no validated tool for addressing self-care behaviors related to HF in Korea. This study aimed to validate the Korean version of the EHFScBS-9. A cross-sectional study was adopted. The EHFSeBS-9 was translated and back-translated into Korean. A convenience sample of 270 patients from an outpatient clinic participated. Reliability was assessed via an internal consistency analysis. Construct validity was tested with exploratory factor and confirmatory factor analysis. Criterion validity was assessed by measuring participants' health literacy and general health status. Internal consistency was supported based on a Cronbach's α of .84. We identified three well-fitting factors (consulting behaviors, fluid restriction, and adherence behaviors), which explained 71.85% of the variance in self-care. More self-care behaviors were associated with adequate health literacy and good general health status. The Korean version of the EHFSeBS-9 showed sufficient internal consistency and acceptable validity to support its usage among Korean HF patients.

Relationship between self-care and social and clinical conditions of patients with heart failure

Objective: to identify the relationship between self-care measures and the social and clinical conditions of patients with heart failure. Methods: a cross-sectional study with 100 patients with heart failure, in outpatient follow-up. To assess self-care, the European Heart Failure Self-care Behavior Scale was used. Descriptive and inferential statistics were applied. Results: the self-care score presented an average of 35.17 ± 7.87, with a variation of 15 to 54 points. A lower average was found in the self-care score for female patients, with a significant difference (p <0.009). The recognition of the presence of lower limb edema, the daily monitoring of body weight and the regular practice of physical activity were presented as self-care measures with greater disagreement among the investigated participants. Conclusion: a better relationship was found between the self-care measures and the female sex.

Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study.

AimsThere are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio‐economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio‐economic factors were associated with patient‐reported outcome measures (PROMs).Methods and resultsIn this cross‐sectional survey, PROMs were measured with seven validated instruments, as follows: self‐care (the 12‐item European Heart Failure Self‐Care Behaviour scale), HF‐related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care—‘Patients' evaluation’), health status (EQ‐5D visual analogue scale), health‐related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status.The patients' (n = 124, mean age 73 ± 14.9, 69% male) self‐care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF‐specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1–6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ‐5D) on average at 65.5 (scale 0–100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care‐related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out‐of‐pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out‐of‐pocket expenses after the crisis, income, or whether patients lived alone or with others.ConclusionsThis Icelandic patient population reported similar health‐related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

Capability for self-care of patients with heart failure.

BackgroundA thorough analysis of the capability for self-care in patients with heart failure (HF) reduces the frequency of hospitalizations that are caused by decompensation. The aim of the study was to assess the effect of the method of therapy for HF, the degree of the acceptance of illness, and the occurrence of frailty syndrome on adherence to the therapeutic recommendations and self-care in patients with HF.MethodsThe study included 180 patients who were hospitalized after being diagnosed with HF. In all, we used the Polish versions of three validated instruments: the nine-item European Heart Failure Self-care Behavior Scale, Illness Acceptance Scale, and The Tilburg Frailty Indicator.ResultsThe capability for self-care of patients with HF was 27.8%. More than 65% of the patients followed the recommendations for taking medication and also followed a low-sodium diet, while only 5.5% of the patients followed the recommendations for physical exercise. Positive correlations were found between the capability for self-care and frailty syndrome and its components: general frailty components vs the capability for self-care: r=0.4449, P=0.0000; physical frailty components vs the capability for self-care: r=0.3974, P=0.0000; emotional frailty components vs the capability for self-care: r=0.2831, P=0.0001; social frailty components vs the capability for self-care: r=0.2180, P=0.0032, and a negative correlation between the capability for self-care and the degree of the acceptance of the illnesses (r=−0.4662, P=0.0000).ConclusionA relatively low capability for self-care was found in patients with HF. The presence of frailty syndrome and a low level of the acceptance of illness are connected with a low capability for self-care.

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.