Heart Failure Self-care Behaviour Scale Research Articles

Self-care and its predictors among patients with heart failure in Karachi, Pakistan

Background: Self-care in heart failure (HF) is essential to improve Quality of Life (QoL) and reduce hospital readmissions. It is a well-researched phenomenon in western countries but still unexplored in developing countries like Pakistan. Aim: The aim of this study was to explore the level of self-care behaviour (SCB) and its associated factors among patients with HF in Karachi Pakistan. Methods: In a cross-sectional survey, SCB was measured from 230 patients with HF, using the European Heart Failure Self-Care Behavior scale (EHFSCBs_9). Its associated factors were assessed via a self-developed checklist prepared by the researcher (lead author). Results: The overall mean of SCB was 29.73+/-7.03. As a result of multi-variable regression analysis, out of the six variables, only three variables were significantly associated with SCB, explaining the 23.4% variance. These variables were education; income; and chronicity of HF diagnosis. Conclusion: The findings of the study suggest that public health initiatives in the form of supportive-educative interventions are a dire need to enhance self-care among patients with HF.

Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado

ObjectiveTo determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DesignCross-sectional and multicentre study. SettingPrimary Care. ParticipantsSubjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. Main measurementsSelf-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. ResultsA total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: −1.37; −1.85 to −0.90), and coronary heart disease diagnosis (−2.41; −4.36: −0.46). ConclusionSelf-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.

Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis.

Background:Self-care is assumed to benefit health outcomes in patients with chronic heart failure (HF), but the evidence is conflicting for health-related quality of life (HRQOL). The aim of this study was to examine the association of (changes in) self-care with HRQOL while adjusting for psychological distress.Methods:In total, 459 patients (mean age = 66.1 ± 10.5 years, 73% male) with chronic HF completed questionnaires at baseline and at 6, 12 and 18 months of follow-up. Self-care and HF-specific HRQOL were quantified with the European Heart Failure Self-care Behaviour scale and the Minnesota Living with Heart Failure Questionnaire.Results:Using general linear models, multivariable between-subject (estimate = –0.14, p = 0.005) and no within-subject effects of self-care were found for better HRQOL over time. Associations between self-care and HRQOL were fully explained by depression (estimate = 1.77, p < 0.001). Anxiety (estimate = 4.49, p < 0.001) and Type D personality (estimate = 13.3, p < 0.001) were associated with poor HRQOL, but only partially accounted for the relationship between self-care and emotional HRQOL.Conclusions:Self-care was prospectively associated with better disease-specific HRQOL in patients with HF, which was fully accounted for by depression, and partially accounted for by anxiety and Type D personality. Changes in self-care within a person did not affect HRQOL. Psychological distress should be considered in future efforts to address self-care and HRQOL.

Patterns, relevance and predictors of heart failure dyadic symptom appraisal.

Caregivers are thought to play a major role in helping patients first appraise and then respond to heart failure (HF) symptoms. The aims of this study were to: (a) characterise distinct patterns of HF patient-caregiver dyads with respect to symptom appraisal; and (b) link dyadic symptom appraisal to contributions to self-care and caregiver strain. A cross-sectional dyadic descriptive design was used to capture patient and caregiver appraisal of patient HF symptoms (i.e. dyspnoea, fatigue, pain and anxiety). Contributions to self-care were measured using patient and caregiver versions of the Self-Care of Heart Failure Index and the European Heart Failure Self-care Behaviour Scale. Caregiver strain was measured using the Multidimensional Caregiver Strain Index. Multilevel and latent class mixture modelling (LCMM) were used to examine distinct patterns of symptom appraisal. Two patterns of dyadic symptom appraisal were identified: one pattern ( n = 24; 38.7%) wherein caregivers appraised patients' symptoms as being significantly worse than did the patient (labelled as 'Caregiver > Patient'); and a second pattern ( n = 38; 61.3%) wherein patients appraised their symptoms similar to or worse than that as perceived by their caregiver (labelled as 'Patient ⩾ Caregiver'). Dyads in the Caregiver > Patient pattern of symptom appraisal reported much better contributions to self-care (symptom response behaviours only), but also greater caregiver strain, compared with dyads in the Patient ⩾ Caregiver pattern. Greater patient depression and older caregiver age were significant determinants of fitting the Patient ⩾ Caregiver pattern. Differences in how HF patients and caregivers appraise symptoms together must be taken into consideration when examining contributions to HF care and caregiver outcomes.

Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies.

Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing. The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored. We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies. A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors.

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis.

Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

The use of platform for remote monitoring on the base of mobile app for improving self-care in patients with chronic heart failure

To determine a possibility for improving the capability of patients with chronic heart failure (CHF) for self-care and self-control using a remote monitoring platform on a basis of mobile application. The study included 142 patients with CHF of different etiology. During the stay in hospital, patients attended structured classes on different aspects of self-control and self-care in CHF. The group of active management consisted of 47 patients who subsequently used a version of mobile application. The control group consisted of 95 patients with CHF. The remote monitoring platform was based on a translated to Russian version of the European Heart Failure Self-Care Behavior Scale (EHFScBS_9), which included 9 items addressing different issues of selfcontrol. Responses were presented as a scale ranging from "completely agree" (1) to "completely disagree (5). The total score was calculated by adding scores for each item. The lower the score the better was the capability of CHF patients for self-care. The followup duration was 6 months. On admission, the mean EHFScBS_9 score decreased to 15±2.3 in the mobile application group whereas in the control group, the mean score was 23.95±3.02, which indicated a significantly better capability for self-care in the mobile application group (p.

Association between self-care and hospital readmissions of patients with heart failure.

to assess the association between self-care and the number of hospital readmissions of patients with heart failure (ADHF) and test the applicability of two self-care assessment tools. longitudinal study, performed in a cardiology reference hospital in southern Brazil. it included 82 patients with a mean age of 61.85±12.33 years, 57.3% male. The mean score of self-care assessment found the scales European Heart Failure Self-care Behavior Scale and Self-care Scale for Patients with Heart Failure was unsatisfactory. it was observed an average of 2.57±1.66 rehospitalization last year for decompensated heart failure. There was a correlation between self-care scores with the number of hospital readmissions for decompensated HF. Education and age were associated to self-care of HF patients. both scales assess self-care in a relevant way, and correlated their indexes.

Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria

ObjectivesThe level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. DesignA multicentre cross-sectional study. Setting10 Primary care centres from the metropolitan area of Barcelona. ParticipantsPatients diagnosed with heart failure. Inclusion criteria: to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Main measurementsHealth Literacy Survey–European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. ResultsThe study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). ConclusionsIn patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure.

Validity and reliability of the Danish version of the 9-item European Heart Failure Self-care Behavior Scale.

To assess the self-care of patients with heart failure (HF), reliable and validated instruments are needed. The aim of this study was to test the validity and reliability of the Danish version of the European Heart Failure Self-care Behavior Scale (EHFScBS-9) based on previous studies reporting 1, 2 and 3 factors, respectively. A convenience sample of 147 patients with HF completed the EHFScBS-9. Psychometric properties of the Danish version of the EHFScBS-9 were tested with factor loadings, factor correlations and goodness-of-fit indices for four different measurement models based on confirmatory factor analysis. All of the items, except item 9 about regular exercise, demonstrated satisfactory item-total correlation ≥0.30. Regarding the fit of the models on the sample data, the most superior fit was observed for the two-factor solution in terms of root-mean-square error of approximation (RMSEA), goodness-of-fit index (GFI), adjusted GFI (AGFI) and comparative fit index (CFI), which all reached the predefined threshold value, except for the normed fit index (NFI) at 0.90. Factor score determinacy (FSD) for the four models tested was 0.88 for the one-factor solution, 0.54 and 0.87 for the two-factor model, 0.83-0.55 for the first three-factor model and 0.87-0.38 for the second three-factor model. The EHFScBS-9 questionnaire is a valid and reliable instrument to assess heart failure-specific self-care behaviours in a Danish population.

Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure

ObjectivesThis study examined the association of self-care with all-cause mortality in a cohort of patients with chronic heart failure (HF). BackgroundAlthough self-care is crucial to maintain health in patients with chronic HF, studies examining an association with clinical outcomes are scarce. MethodsConsecutive patients with chronic HF (n = 559, mean age 66.3 ± 9.5 years, 78% men) completed the 9-item European Heart Failure Self-care Behaviour scale. Our endpoint was all-cause mortality. Associations between self-care and all-cause mortality were assessed with Kaplan-Meier analyses and multivariable Cox regression accounting for standard sociodemographic and clinical covariates, psychological distress, and self-rated health. ResultsAfter a median follow-up of 5.5 ± 2.4 years (range 16 weeks to 9.9 years), 221 deaths (40%) from any cause were recorded. There was no evidence of a mortality benefit in patients high over those low in global self-care (p = 0.71). In post hoc analyses, low self-reported sodium intake was associated with increased mortality (adjusted hazard ratio: 1.47; 95% confidence interval: 1.10 to 1.96; p = 0.01). Other significant predictors of mortality were: male sex, lack of a partner, New York Heart Association functional class III to IV, and increasing comorbid conditions. ConclusionsGlobal self-care was not associated with long-term mortality whereas low self-reported sodium intake independently predicted increased all-cause mortality beyond parameters of disease severity. Replication of findings is needed as well as studies examining the correspondence of subjectively and objectively measured sodium intake and its effects on long-term prognosis in patients with chronic HF.

How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study

BackgroundAlthough the effectiveness of heart failure (HF) disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting.MethodsWe developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1:1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS). Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death.ResultsA total of 32 patients were enrolled (mean age, 63 years; 31% female). There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098). During a 2-year follow-up, the HF program was related to better outcomes regarding HF hospitalization and/or cardiac death (14% vs 48%, log-rank test P=0.04). In Cox regression analysis after adjustment for age, sex, and logarithmic of B-type natriuretic peptide, the program was associated with a reduction in HF hospitalization and/or cardiac death (hazard ratio, 0.17; 95% confidence interval, 0.03–0.90; P=0.04).ConclusionThe HF program was likely to increase patients’ HF knowledge, change their behavior regarding a low-salt diet, and reduce HF hospitalization and/or cardiac events. Further improvement focused on the transition of knowledge to self-care behavior is necessary.

Polish adaptation and reliability testing of the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS).

According to the guidelines of the European Society of Cardiology, education in heart failure (HF) should focus on preparing the patient for self-control and self-care. Only systematic assessment of the level of self-care in HF enables the optimisation and adaptation of education to meet the patient's needs. The research tool commonly used to assess self-care in HF patients is the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). To test the reliability of the Polish version of the 9-EHFScBS. A standard guideline was used for the translation and cultural adaptation of the English version of the 9-EHFScBS into Polish. The study included 110 Polish patients (mean age 66.0 ± 11.4 years); 51 men and 59 women. Cronbach's alpha was used for the analysis of the internal consistency of the 9-EHFScBS. The mean overall level of self-care in the study group was 27.65 points (SD 7.13 points). Good or satisfactory levels of self-care were found in three out of nine analysed variables. The reliability of the self-care scale was alpha = 0.787. The value of Cronbach's alpha after the exclusion of individual statements ranged from 0.75 to 0.81. The 9-EHFScBS questionnaire is a reliable research tool in assessing the level of self-care among patients with HF in the Polish population.

Abstract 16329: Multimorbidity and Quality of Life in Heart Failure Patients With Poor Self-care Behavior

Introduction: Multimorbidity, the co-occurrence of various chronic conditions, is of major concern in patients with heart failure (HF) because it is associated with impaired quality of life (QOL) and adverse outcomes. Effective self-care is an essential adjunct to evidence-based medical treatment aimed at delaying progression of HF. Hypothesis: This study investigated the relationships between multimorbidity, QOL and level of self-care in HF patients. Methods: Study subjects completed questionnaires on HF-related quality of life (Minnesota Living with Heart Failure questionnaire), HF-related self-care behaviors (European Heart Failure Self-Care Behavior Scale), HF-related knowledge (Japanese heart failure knowledge scale) and depression symptoms. Comorbidities and other clinical and social characteristics were also assessed. Analyses of covariance and multivariate linear regression were used to assess associations between multimorbidity and QOL. Results: A total of 231 outpatients with HF were assessed; 119 with poor self-care (self-care score&lt; 34) and 112 with adequate self-care (self-care score≥34); mean age 65.8 ± 13.9 and 69.8 ± 13.7 years, respectively. Of these patients, 57.6% had three or more additional chronic conditions; the most prevalent being hypertension (56.0%) and chronic kidney disease (46.6%). Patients with multimorbidity had worse QOL than patients without (P &lt; 0.01). Subjects with poor self-care and multimorbidity had worse QOL than those without multimorbidity (P &lt; 0.01); however, there was no association between multimorbidity and QOL in patients with adequate self-care. Multivariate analysis controlling for the effects of other variables showed that multimorbidity was an independent determinant of QOL overall and in poor self-care patients (sβ = 0.15, P = 0.04; sβ = 0.28, P &lt; 0.01, respectively). However, in patients with adequate self-care, multimorbidity was not associated with QOL. Conclusions: Multimorbidity is an independent determinant of QOL in HF patients with poor self-care. To improve their QOL, both reinforcement of adequate self-care behavior regarding their HF and a multidimensional approach to enhancing self-management of their comorbidities are needed.

The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure.

BackgroundSelf-care behavior is essential for achieving good outcomes among patients with heart failure. Understanding the factors associated with self-care over time is important for the provision of appropriate and targeted interventions. However, little is known regarding the changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure.ObjectiveTo investigate the changes and factors of self-care behaviors during the first 3 months following discharge among patients with heart failure in the People’s Republic of China.MethodsA descriptive design with a convenience sample was utilized in this study. Patients (N=128) from two hospitals, West China Hospital and Angjin Hospital, in Chengdu, People’s Republic of China, were recruited from June 2013 to June 2014. The instruments used in the study included the following: the Social Support Rating Scale, the Hospital Anxiety and Depression Scale, the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the European Heart Failure Self-Care Behaviour Scale. Multivariate linear regression analyses were used to identify the factors related to self-care behaviors at baseline, 1 month, and 3 months following discharge.ResultsPatients’ self-care behaviors were poor and decreased significantly over time (F=4.09, P<0.05). The factors associated with self-care behaviors at baseline included the following: education level, comorbidities, and social support. The factors related to self-care behaviors at 1 and 3 months following discharge included the following: education level, comorbidities, social support, and self-efficacy. The variances in self-care behaviors attributed to these factors were 43%, 46%, and 42% at baseline, 1 month, and 3 months following discharge, respectively.ConclusionAdditional support should be provided to patients with heart failure with low educational levels and patients with multiple comorbidities. Follow-up, continuity of care, and family caregiver integration following discharge are necessary for the said patients to improve their self-care behaviors and obtain better outcomes.

Adherence to self-care in patients with heart failure in the HeartCycle study.

PurposeThe purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient.Patients and methodsThe evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days) admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA) Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system’s database.ResultsOf 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (P<0.001), and fluid restriction (P<0.05). Average adherence (n=120) to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%.ConclusionSelf-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.

Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation.

PurposeTo describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors.Patients and methodsCross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile.ResultsPatients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0±19.6) before the procedure. Patients had on average 8.2 (±4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Expβ 0.049, P=0.033).ConclusionHeart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

Telehealth on heart failure: results of the Recap project

Telehealth has become a very important tool that allows the monitoring of heart failure patients in a home environment. However, little is known about the effect that such monitoring systems have on patients’ compliance, evolution and self-care behaviour. In particular, the effect that the selected user interface has on these factors is unknown. This study aims to investigate this, and to determine some practicalities that must be considered when designing and implementing a telehealth programme for heart failure. To achieve this, daily measurements of blood pressure, pulse, SpO2 and weight were collected from 534 patients suffering from heart failure. In addition, they were asked to fill in the European heart failure self-care behaviour scale questionnaire and the EQ-5D quality of life questionnaire, before and after the monitoring period. Two telehealth systems were used, the Motiva platform provided by Philips and the standalone unit provided by Docobo, the Doc@Home system. Significant differences were found between both systems concerning the compliance and adherence of patients. Moreover, a general, positive effect of telehealth was identified due to the fact that patients showed an increased self-awareness when managing their condition. These findings are supported by behavioural changes and a better understanding of heart failure from the patients’ perspective.

Self-Care Behavior and Depression in Patients with Heart Failure*

Purpose: The purpose of this study was to examine levels of self-care behavior according to levels of depression among patients with heart failure (HF). Met hods: Participants in this descriptive research were 169 outpatients with HF who being seen in three university hospitals and one general hospital located in B, Y, and D cities. Data were collected using the Korean version of the Center for Epidemiologic Depression Scale and European Heart Failure Self-care Behavior Scale. Data collection period was from April 25, 2012 to September 26, 2013. Data were analyzed using Chi-square tests and ANOVAs with SPSS WIN 21.0. Results: A higher proportion of patients who were female, without a spouse, with lower household income, not employed, and having lower functional status with serious symptoms of HF tended to be clinically depressed. HF patients with depression tended not to report symptom changes to their health care providers. Conclusion: The findings of this study indicate the need to screen for depression in patients with HF and to develop strategies to improve self-care behaviors in these patients in order to promote reporting of symptom changes to health care providers.

The association between cognitive function and self-care in patients with chronic heart failure

BackgroundSelf-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression. MethodsThis cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses. ResultsPsychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression. ConclusionsDeficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.