Heart Failure Self-care Behaviour Research Articles

Predicting depressive symptoms and self-care in patients with heart failure.

To examine relationships among heart failure (HF) physical symptoms, social support, social problem-solving, depressive symptoms, and self-care behaviors in outpatients with HF. Cross-sectional data were collected from 201 outpatients. Structural equation modeling was used in this preliminary analysis to examine the relationships among the study variables. HF physical symptoms and social support were predictors of depressive symptoms and self-care behaviors. Social problem-solving also predicted self-care behaviors. Social support mediated the relationship between HF physical symptoms and depressive symptoms. Social support may influence depressive symptoms and self-care behaviors, whereas social problem-solving may impact self-care behaviors. Future research should examine causality and sub-components of social problem-solving on these outcome variables.

Adherence to Self-Care Behaviours and Knowledge on Treatment among Heart Failure Patients in Ethiopia: The Case of a Tertiary Teaching Hospital

Aim: Non adherence to self-care behaviour is common in patients with heart failure leading to reduced quality of life, increased morbidity, mortality and health care costs. We assessed adherence to self-care behaviours and knowledge among adult patients with heart failure on active follow up. Method and results: Hospital based cross-sectional study was employed and patient reported adherence to self-care behaviours and knowledge on heart failure was assessed among 328 adult heart failure patients. The mean (± standard deviation (SD)) age was 52 (± 17) years; 55.5% were men. Among 26 self-care behaviours studied, four of the top eight most frequently performed were related to taking prescribed medications, and the seven least frequently performed ones were concerned with symptom monitoring or management. Adherence to individual self-care behaviours ranged from 9.7% to 99.7% however, cumulative good adherence was low at 62.7%, and only 17.4% of patients reported good adherence with all 26 self-care recommendations, indicating high rates of selective adherence. The mean (± SD) total knowledge score was 7.38 ± 2.2 out of a maximum score of 14. Multivariate analysis showed that age, co-morbidity, NYHA functional class and heart failure knowledge score were independent predictors of poor adherence to self-care behaviours (P<0.01). Conclusion: Overall adherence to heart failure self-care behaviours is low and selective. Majority of patients had a sever knowledge deficit related to heart failure and self-care behaviours. Age, co-morbidity, NYHA class and heart failure knowledge score were independent predictors for poor over all adherences.

Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

Purpose: To evaluate heart failure knowledge and adherence to self-care behaviors, and to identify factors affecting adherence to self-care behaviors among Korean patients with heart failure. Methods: Correlational research using the European Heart Failure Self-care Behavior Scale, the Duke Activity Status Index, the Dutch Heart Failure Knowledge Scale, the New York Heart Association Functional Classification, and the Medical Outcomes Study Social Support Survey was conducted. A total of 280 outpatients with heart failure responded to the five questionnaires. Results: The mean scores for self-care adherence and heart failure knowledge were 31.98 ± 6.81 and 8.78 ± 2.53, respectively, indicating lower adherence and knowledge than those previously reported. Subjects with lower functional status, more social supports, and greater knowledge of heart failure are more likely to adhere to prescribed regimens. Conclusion: Nurses should focus on patient education and support to improve their adherence to self-care behaviors.

Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure.

Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (β = 34.265, R 2 = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care.

Cross-cultural adaptation and reliability testing of Polish adaptation of the European Heart Failure Self-care Behavior Scale (EHFScBS).

BackgroundDevelopment of simple instruments for determination of self-care levels in heart failure (HF) patients is a subject of ongoing research. One such instrument, gaining growing popularity worldwide, is the European Heart Failure Self-care Behavior Scale (EHFScBS). The aim of this study was to adapt and to test reliability of the Polish version of EHFScBS.MethodA standard guideline was used for translation and cultural adaptation of the English version of EHFScBS into Polish. The study included 100 Polish HF patients aged between 24 and 91 years, among them 67 men and 33 women. Cronbach’s alpha was used for analysis of the internal consistency of EHFScBS.ResultsMean total self-care score in the study group was 34.2±8.1 points. Good or satisfactory level of self-care were documented in four out of 12 analyzed EHFScBS domains. Cronbach’s alpha for the entire questionnaire was 0.64. The value of Cronbach’s alpha after deletion of specific items ranged from 0.55 to 0.65.ConclusionPolish HF patients present significant deficits of self-care, which are to a large extent associated with inefficacy of the public health care system. Apart from cultural characteristics, the socioeconomic context of the target population should be considered during language adaptation of EHFScBS, as well as during interpretation of data obtained with this instrument. A number of self-care–related behaviors may be optimized as a result of appropriate educational activities, also those offered by nursing personnel.

Heart failure self-care interventions to reduce clinical events and symptom burden

Heart failure self-care interventions to reduce clinical events and symptom burden Mary H McGreal,1 Maureen J Hogan,1 Colleen Walsh-Irwin,1 Nancy J Maggio,2 Corrine Y Jurgens1 1School of Nursing, Stony Brook University, Stony Brook, NY, USA; 2School of Nursing, Farmingdale State College, Farmingdale, NY, USA Background: Lack of adherence to prescribed therapies and poor symptom recognition are common reasons for recurring hospitalizations among heart failure (HF) patients. The purpose of this literature review is to examine the effectiveness of HF self-care interventions in relation to clinical events and symptom burden. Methods: A systematic review of randomized controlled trials with a HF self-care measure was conducted. The PubMed, CINAHL, and Medline databases were searched between 2010 and 2014, using the keyword &ldquo;heart failure&rdquo; in combination with the terms &ldquo;self-care&rdquo;, &ldquo;self-management&rdquo;, &ldquo;self-care maintenance&rdquo;, &ldquo;self-care confidence&rdquo;, &ldquo;symptoms&rdquo;, and &ldquo;hospitalizations&rdquo;. Outcomes of interest were clinical events and/or symptom burden. Results: Nine studies met the inclusion criteria. HF education was the core of all interventions examined. Dose and strategies varied across studies. All interventions that effectively decreased clinical events included education on how to respond to worsening HF symptoms. Conclusion: Knowledge alone does not improve HF self-care behaviors or reduce the risk of clinical events and/or symptom burden. Interventions that augment self-confidence or self-efficacy to perform optimal self-care management and self-care maintenance may be useful. Keywords: heart failure, self-care, self-management, self-care maintenance, self-care confidence, symptoms, hospitalizations

Positive affect, anhedonia, and compliance with self-care in patients with chronic heart failure

ObjectiveOptimal self-care is crucial in patients with chronic heart failure (HF). While the focus of research has been on negative mood states, adequate psychological resources may be required to successfully engage in HF self-care. Therefore, the longitudinal associations of multiple positive affect measures in explaining HF self-care including consulting behavior were examined while adjusting for depressive symptoms and potential covariates (e.g., disease severity). MethodsIn this prospective cohort study, 238 patients (mean age: 66.9±8.6years, 78% men), with chronic HF completed questionnaires at baseline and 1-year follow-up. Positive affect was assessed with the Positive and Negative Affect Schedule (PANAS) and the Global Mood Scale (GMS). Anhedonia, i.e. diminished interest or pleasure, was assessed with a subscale of the Hospital Anxiety and Depression Scale (HADS). The 9-item European Heart Failure Self-care Behaviour scale was completed to assess HF self-care including consultation behavior. ResultsLinear mixed modeling results showed that anhedonia was most strongly associated with both poor self-care (estimate=−.72, P<.001) and consulting behavior (estimate=−.44, P<.001) over time, after adjustment for covariates and depressive symptoms. GMS positive affect was related to better HF self-care adjusting for standard depressive symptoms but not when adjusting for anhedonia. PANAS positive affect was not independently related to self-care. ConclusionAnhedonia was associated with worse compliance with self-care among chronic HF patients over time, irrespective of disease severity and depression. Associations between positive affect and self-care were dependent on the measures used in multivariable analyses.

The Greek version of the 9-item European heart failure self-care behaviour scale: A multidimensional or a uni-dimensional scale?

ObjectivesTo evaluate the dimensionality of the Greek version of the European Heart Failure Self-care Behaviour Scale (Gr9-EHFScBS) in a Greek – Cypriot population. BackgroundEHFScBS is a valid and reliable scale which is widely used for assessing heart failure (HF) patients' self-care behaviors. MethodsEHFScBS was translated into Greek and was administered to 128 Greek-Cypriot HF patients. The internal consistency, construct validity and discriminant validity of the scale were assessed. ResultsConfirmatory factor analysis failed to capture the proposed theoretical structure. Further exploratory factor analysis provided a three-factor solution accounting for 53.35% of the variance, though the scale is better used as a whole. Cronbach's alpha was moderate 0.66, but deletion of any item decreased the alpha coefficient. Discriminant validity was supported by the poor correlation between EHFScBS and Minnesota Living with Heart Failure Questionnaire scores. ConclusionEven though results do not conform to the multidimensionality of the scale, assessment of the tool provided acceptable validity and reliability measures to support its usage among Greek speaking populations.

Knowledge is insufficient for self-care among heart failure patients with psychological distress.

We conducted a study to identify barriers to, and factors promoting, self-care among heart failure (HF) patients with higher or lower levels of knowledge. Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed. Using median splits on the HF Knowledge Scale and the European HF Self-Care Behavior Scale, patients were divided into four groups: (a) low knowledge and good self-care, (b) low knowledge and poor self-care, (c) high knowledge and good self-care, and (d) high knowledge and poor self-care. Characteristics of the groups were compared using ANOVA, Kruskal-Wallis tests, and chi-square tests, followed by pairwise tests with Bonferroni correction. Variables significant in the univariate analyses were evaluated as predictors of self-care using hierarchical multiple linear regression. The potential moderating effect of knowledge was tested with interaction terms. The four groups did not differ in sociodemographics or health literacy scores, but differed in New York Heart Association (NYHA) class, comorbidities, and scores on depression, anxiety, and perceived control. In post hoc pairwise tests, patients with high knowledge and poor self-care tended to have worse NYHA class, greater depression and anxiety, and lower levels of perceived control than others. In the multivariate analysis, knowledge, depressive symptoms, and perceived control were significant predictors of self-care, as was the interaction between knowledge and anxiety. Screening and treatment of depression and anxiety is important in improving self-care among HF patients. HF management programs need to include strategies for increasing patients' perceived control over their heart disease.

The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review

Review objectives The objective of this review is to synthesize the best available evidence regarding the effectiveness of patient centered self-care education for adult patients with heart failure relating to heart failure knowledge, self-care behaviors centered on heart failure, heart failure-related quality of life, and heart failure readmissions within one year of an index hospitalization. A secondary objective of this review is to determine the most effective education approach for interventions included in the review to deliver patient-centered self-care education to adult patients with heart failure. Inclusion criteria Types of participants This review will consider studies that include all adult patients, 18 years and older, of any race, ethnicity, or gender with a diagnosis of HF regardless of etiology, severity, duration of HF, or presence of comorbid conditions. Type of intervention This review will consider all types of patient-centered, self-care education interventions for adult patients with HF provided by any health care provider, regardless of frequency, duration and intensity. For this review, patient-centered, self-care education interventions are defined as interventions designed towards the patient as a unique individual, taking into consideration a patient’s individual needs, preferences and values. The patient is the central focus of the planned intervention with a goal of meeting patient specific self-care educational goals and desired outcomes. Comparator intervention This review will consider as comparators standard care or non-patient-centered education programs such as written or video taped education materials that have not been individualized to a patient’s specific needs, preferences or values. Types of outcomes This review will consider studies that include the following outcomes as measured by valid and reliable instruments within one year post-intervention: Heart failure knowledge such as knowledge related to the general pathophysiology of HF, treatment strategies, and signs/symptoms of HF as measured by valid and reliable instruments such as the Atlanta Heart Failure Knowledge Test (A-HFKT). Heart failure self-care behaviors including, but not limited to, HF management, symptom monitoring, and implementation of treatment strategies as measured by valid and reliable instruments such as the Self-Care Heart Failure Index (SCHFI) or the European Heart Failure Self-Care Behavior Scale (EHFScBS). Heart failure-related quality of life related to areas such as maintaining physical activity and exercise, symptom burden, self-efficacy, and maintaining social interaction and support, as measured by valid and reliable instruments such as the generic Short Form 36 (SF-36), or HF specific instruments such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or the Kansas City Cardiomyopathy Questionnaire (KCCQ). Heart failure admissions or readmissions within 1 year post intervention. For this review, hospital readmission is the consecutive admission to the same hospital, a different hospital, or another acute care facility related to a specific condition for which treatment was rendered on a previous hospitalization.

Profiles of self-care management versus consulting behaviors in adults with heart failure

Patients with heart failure (HF) vary in their ability to respond to symptoms when they occur. The goal of this study was to classify common patterns of symptom response behaviors among adults with HF and identify biobehavioral determinants thereof. Consulting behaviors (i.e. contacting a provider for guidance) were measured using the European Heart Failure Self-care Behavior Scale consulting behaviors subscale, and self-care management (i.e. recognizing and engaging in self-initiated treatment of symptoms) was measured with the Self-Care of HF Index self-care management scale in a prospective cohort study. Latent class mixture modeling was used to identify distinct profiles of consulting and of self-care management behaviors. The mean age (n=146) was 57±13 years, 30% were female, and 59% had class III/IV HF. Two distinct profiles of consulting behaviors (novice and expert) and three distinct profiles of self-care management (novice, inconsistent and expert) were identified. There was a weak association between profiles of consulting behaviors and self-care management (Kendall's tau-b=0.211). Higher levels of anxiety were associated with worse consulting behaviors (β=1.67±0.60) and worse self-care management (β= -5.82±3.12) and lower odds of exhibiting expert level consulting behaviors (odds ratio (OR)=0.50; 95% confidence interval (CI)=0.26-0.95) and self-care management (OR=0.47; 95% CI=0.24-0.92) (all p<0.05). Higher levels of physical symptoms were associated with better self-care management (β=0.50±0.12; OR =1.02, 95% CI=1.00-1.05; both p<0.05). Expertise in consulting behaviors does not necessarily confer expertise in symptom self-care management and vice versa. Physical and psychological symptoms are strong determinants of symptom response behaviors.

Blunted Responses to Heart Failure Symptoms in Adults With Mild Cognitive Dysfunction

Mild cognitive dysfunction is common among adults with heart failure (HF). We hypothesized that mild cognitive dysfunction would be associated with poor HF self-care behaviors, particularly patients' ability to respond to symptoms. We analyzed data on 148 participants in an observational study of symptoms in adults with moderate-to-advanced HF. Mild cognitive dysfunction was measured with the Montreal Cognitive Assessment (MoCA; range, 0-30), using cutoff scores for the general population (26) and for adults with cardiovascular disease (24). Heart failure self-care management (evaluation and response to HF symptoms) was measured with the Self-care of HF Index, and consulting behaviors (calling a provider when symptoms occur) were measured using the European HF Self-care Behavior Scale-9. Generalized linear modeling and hierarchical linear modeling were used to quantify the relationship between MoCA cutoff scores and indices of HF self-care. The mean age of the sample was 57 ± 12 years, 61.5% were men, and 58.8% had class III/IV HF; the mean left ventricular ejection fraction was 28% ± 12%. Using MoCA scores of 26 and 24, respectively, 33.1% and 14.2% of the sample had mild cognitive dysfunction. Controlling for common confounders, participants with MoCA scores lower than 26 reported self-care comparable with that of participants with MoCA scores of 26 or higher. Participants with MoCA scores lower than 24, however, reported 21.5% worse self-care management (P = 0.014) and 51% worse consulting behaviors (P < 0.001) compared with participants with MoCA scores of 24 or higher. A disease-specific cutoff for mild cognitive dysfunction reveals marked differences patients' ability to recognize and respond to HF symptoms when they occur. Adults with HF and mild cognitive dysfunction are a vulnerable patient group in great need of interventions that complement HF self-care.

Educational level and self-care behaviour in patients with heart failure before and after nurse educational intervention

Self-care is important for heart failure (HF) management and may be influenced by the patient's educational level. We assessed the relationship of educational level with baseline self-care behaviour and changes one year after a nursing intervention in HF outpatients attending a HF unit. Three hundred and thirty-five HF patients were studied, with a median age of 67 years (P(25-75) 57-75) and a median HF duration of six months (P(25-75) 1-36). HF aetiology was mainly ischaemic heart disease (53.4%). Median ejection fraction was 30% (P(25-75) 24-37%). The functional class was mainly II (66.3%) and III (25.7%). Educational levels were: very low 17.3%; low 62.1%; medium-high 20.6%. Patients were evaluated at the first visit (baseline) and one year after the educational intervention with the nine-item European Heart Failure Self-care Behaviour Scale. Median patient scores differed in the baseline (19 (P(25-75) 15-26) vs. 16 (P(25-75) 13-21) vs. 15 (P(25-75) 12.5-15.5)) and the one-year evaluation (15 (P(25-75) 13-17) vs. 13 (P(25-75) 11-15) vs. 12 (P(25-75) 10-14)) for the three educational levels, respectively, with statistically significant differences between levels (p=0.007 to p<0.001) except between low and medium-high education at one year (p=0.057). In the one-year evaluation, self-care behaviour significantly improved in the three educational groups (p<0.001), with a similar, albeit not statistically significant, magnitude of improvement in all groups. Self-care behaviour at baseline and one year after a nursing intervention was better in patients with a higher education, although the improvement with the intervention was similar irrespective of the educational level.

A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes

Studies show 30% to 47% of people with heart failure (HF) have concomitant diabetes mellitus (DM). Self-care for persons with both of these chronic conditions is conflicting, complex, and often inadequate. This pilot study tested an integrated self-care program for its effects on HF and DM knowledge, self-care efficacy, self-care behaviors, and quality of life (QOL). Hospitalized HF-DM participants (N = 71) were randomized to usual care or intervention using a 1:2 allocation and followed at 30 and 90 days after intervention. Intervention was an integrated education and counseling program focused on HF-DM self-care. Variables included demographic and clinical data, knowledge about HF and DM, HF- and DM-specific self-efficacy, standard HF and DM QOL scales, and HF and DM self-care behaviors. Analysis included descriptive statistics, multilevel longitudinal models for group and time effects, post hoc testing, and effect size calculations. Sidak adjustments were used to control for type 1 error inflation. The integrated HF-DM self-care intervention conferred effects on improved HF knowledge (30 days, p = .05), HF self-care maintenance (30 and 90 days, p < .001), HF self-care management (90 days, p = .05), DM self-efficacy (30 days, p = .03; 90 days, p = .004), general diet (30 days, p = .05), HF physical QOL (p = .04), and emotional QOL scores (p = .05) at 90 days within the intervention group. The participants in the usual care group also reported increased total and physical QOL. Greater percentages of participants in the intervention group improved self reported exercise between 0 and 30 days (p = .005 and moderate effect size ES = .47) and foot care between 0 and 90 days (p = .03, small ES = .36). No group differences or improvements in DM-specific QOL were observed. An integrated HF-DM self-care intervention was effective in improving essential components of self-care and had sustained (90 day) effects on selected self-care behaviors. Future studies testing HF-DM integrated self-care interventions in larger samples with longer follow-up and on other outcomes such as hospitalization and clinical markers are warranted.

Cognitive impairment and self-care in heart failure

BackgroundHeart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF.DesignProspective cohort study.Setting and participantsA total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada.Measurements and methodsParticipants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors.ResultsA total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models.ConclusionCognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs.

The European Heart Failure Self-care Behaviour Scale: New insights into factorial structure, reliability, precision and scoring procedure

ObjectiveTo evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0–100 score with a higher score meaning better self-care. MethodsA sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD). ResultsWe identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index=0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9. ConclusionThe new factorial structure of the EHFScBS-9 showed supportive psychometric properties. Practice implicationsThe EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier.

Self-care and renal dysfunction in patients with chronic heart failure

Purpose: It has been shown that impaired renal function is a strong predictor of mortality in patients with chronic heart failure (HF). From a behavioural perspective, self-care has been assumed to be a crucial factor in chronic HF patients to maintain health. However, no prior studies have examined whether self-care is associated with improved renal function. Therefore, we prospectively examined the association between HF self-care and renal function at 1-year follow-up. Methods: In total, 482 chronic HF outpatients (mean age 66.2±9.5 years, 74% men) were recruited from 4 teaching hospitals in the Netherlands. All patients completed the shortened 9-item version of the European Heart Failure Self-care Behaviour scale to assess HF self-care and consultation behaviour at baseline and at 1-year follow-up. Renal function was measured at both consecutive time points using glomerular filtration rates of creatinine. Other HF-related pathophysiological markers of HF disease progression were also measured at both time points including heart pump function (left ventricular ejection fraction and brain natriuretic peptide), liver function, and anemia. Results: By means of linear mixed modeling using maximum likelihood estimation, better HF self-care and consultation behaviour were associated with lower glomerular filtration rates over time (p=.009 and p=.06, respectively), indicating worse renal functioning even after controlling for age, sex, disease severity using New York Heart Association functional class, and standard risk factors. In contrast, regular physical activity was associated with better renal function (p=.03). HF self-care was not associated with other pathophysiological markers of disease severity. Conclusions: HF self-care was associated with renal dysfunction over time. While there was no association between self-care and other pathophysiological markers of HF disease severity, physical activity activity was associated with improved renal function over time. Patient's awareness of their renal dysfunction might prompt better self-care, but the true nature of the link between self-care and clinical outcomes in patients with chronic HF warrants more attention in future research.

Critical health literacy as an important determinant of self-care behavior among patients with heart failure

Purpose: Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL has focused predominantly on the functional HL (the ability to read and write), the relationship between comprehensive HL including the ability to access to information (communicative HL) and the ability to evaluate critically (critical HL) and self-care behavior has not been evaluated. This study aimed to determine the relationship between the functional, communicative, and critical HL and self-care behavior on HF patients. Methods: Cross-sectional analysis of data were completed the HL (the comprehensive HL scale), HF-related self-care behaviors (The European Heart Failure Self-Care Behavior Scale) and HF-related knowledge. Socio-demographic (age, gender, education level) and clinical characteristics (etiology, risk factors, comorbidity and severity of HF) were also assessed. We used the analyses of covariance and multivariate linear regression to estimate the associations between three levels of HL and self-care behavior. Results: 189 out of 201 patients with HF were assessed (mean age 66.8±13.9 years; 64.6% males; 46.6% NYHA function classII). Patients with low HL had poor HF-related knowledge and self-care behavior than those with high HL (Knowledge: 9.2 versus. 11.8, P<0.00, Self-care: 35.5 versus. 32.4, P=0.03). Out of the three components of HL, patients with low critical HL had poor self-care behavior than those with high critical HL (35.82 versus 32.70, P=0.03). Functional and communicative HL were not associated with self-care behavior (functional HL: low 33.45 versus high 33.96, P=0.71, communicative HL: low 35.66 versus high 32.91, P=0.80). Multivariate linear regression analysis revealed that critical HL (β= −0.25, P=0.02), HF-related knowledge (β= − 0.21, P=0.03), age (β= −0.01, P < 0.03), and occupation (β= −0.27, P<0.04) were independently associated with self-care behavior. Conclusions: Critical HL was independent associated with self-care behavior in patients with HF. We should develop the effective intervention to improve patient's skills for analyzing critically information and using it to making decisions.

Nurse-based educational intervention in a heart failure unit improves outcomes in self-care, quality of life and depression of high-risk patients with chronic heart failure

Purpose: Self-care management is an important part of Heart Failure (HF) treatment. Multidisciplinary management programmes in Heart Failure Units (HFU) have been encouraged by the latest European Guidelines on Chronic HF. However, no clear interventions have been proved to be effective and tailored different programmes are used in every country. The purpose of this study was to evaluate the impact of a nurse-based educational intervention (NEI) on quality of life of high-risk patients with Chronic HF. Methods: We included patients admitted at our HFU after a HF episode that required hospitalization from February 2011 to October 2012. After discharge and treatment optimization, patients and their carers were offered a 4-weeks NEI. Patients with motility limitations or no possible self-access to our centre were excluded. Standardized tests to measure performance in activities of daily living, cognitive impairment and co-morbidity were performed. Self-care (The European Heart Failure Self-care Behavior (ESS)), quality of life (Minnesota living with heart failure questionnaire (MQ)) and degree of depression, (Yessavage's Geriatric Scale (YS)) were measured and compared pre and 3 months post-NEI. NEI consisted of four weekly consecutive sessions with brochures and audio-visual support that included topics as promoting self-care, recognition of alarm signs and symptoms, flexible diuretic regimen, diet/regular exercise aspects, pharmacological treatment, importance of psychological aspects etc. Results: From 408 patients visited in our HFU during this time, 107 patients (26%) were included in our NEI. 74% were men, mean age was nearly 70 years (range 43-89 years). Mean left ventricle ejection fraction was 31±8%, 91% were on NYHA class II-III and 97% were on ECA-inhibitors/ARB. Included patients were mostly independent in daily living (Barthel mean score (MS):98,5±5,8), without significant cognitive impairment (Pfeiffer's test MS: 0,94±0,52) and with moderate degree of co-morbidities (Charlson co-morbidity index MS: 5,27±2,27). After NEI, our patients showed a statistically significant improvement in quality of life (MQ MS reduction: 3,79, p<000,1), a better self-care (ESS MS reduction: 6,12, p<0,001) and lesser degree of depression (YS MS reduction: 3,36 p=0,001). Conclusions: NEI improved self-management, quality of life and depression symptoms in patients with Chronic HF. This is an important benefit for this special, high-mortality, easily-decompensated population that can suppose an economical cost-reduction for health-care systems. NEI should be promoted to benefit these patients.

The relationship between self-efficacy and self-care behaviors in

The relationship between self-efficacy and self-care behaviors in