Heart Failure Self-care Behaviour Research Articles

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

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

Effects of Remote Patient Management on Self-Care Behaviour in Heart Failure Patients: Results from the randomised TIM-HF2 Trial.

Remote patient management (RPM) in heart failure (HF) patients has beneficial clinical effects. This analysis investigates the effects of RPM used in the Telemedical Interventional Management in Heart Failure II trial on HF-specific self-care. From 2013 to 2017 1,538 HF outpatients (age 70.3±10.5years, 70% men, 52%/47% NYHA II/III, 65% LVEF ≤45%) with a recent HF hospitalisation were included to the study and randomised to Usual Care (UC) plus RPM (n=796) or UC only (n=775), with a 12-month follow-up. Self-reported self-care behaviour at baseline and at end of study was assessed with the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9), obtaining 1,321 patients with valid baseline and follow-up questionnaires for the analysis.EHFScBS-9 sum scores increased in the RPM group (n=667) from 78.7±17 to 84.5±14 and in the UC group (n=654) from 79.0±17 to 80.0±16 from baseline to 12 months (difference in means [MD] 4.58 [3.02, 6.14]; p<0.001) with highest improvement (8.66 [3.52; 13.81]) in patients living alone and having an inadequate (<70) baseline EHFScBS-9. There were differences between both groups in item "I weight myself every day" (MD -1.13 [-1.24, -1.02]; p<0.001), and item "I take my medication as prescribed" (MD -0.06 [-0.10, -0.01]; p=0.014). No correlation was found between the EHFScBS-9 score and the efficacy of RPM on the TIM-HF2 primary endpoint of percentage of days lost due to unplanned cardiovascular hospitalisation or death of any cause. RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen.

The Relationships Among Health Literacy, Patient Activation, and Self-Care Behaviors in Adults With Heart Failure: A Cross Sectional Study

Despite current efforts, adherence to heart failure (HF) selfcare remains suboptimal. There is a need to identify modifiable factors that promote self-care adherence. Evidence suggests that patient activation and health literacy (HL) are modifiable and may be useful for improving HF self-care. However, more research is needed to understand the influences of these variables on HF self-care. The aim of this study was to examine the relationships between patient activation, health literacy, and self-care adherence in a diverse group of adults with HF. This study used a correlational, cross-sectional design. Correlation and regression tests were used to analyze associations among variables. Stratified random sampling was applied to attain a study sample that was 50% persons of color (POC). Of the 174 participants, 51% were female and 48.5% were POC with a mean age of 62 years. There was no significant relationship between HL and HF self-care adherence. There was a small, positive correlation between HL and dichotomized high/low activation levels ( r = .163; p &lt; .05). There was a small, positive correlation between patient activation and HF self-care behaviors ( r = .151; p &lt; .05). However, regression tests showed patient activation was not a predictor of selfcare ( B = 0.173, p = .064). Persons with HF may perform self-care activities when highly activated, regardless of HL status. Patient activation was not a reliable predictor of self-care adherence. More research is needed to elucidate the influence of patient activation and HL on HF self-care behaviors.

Translation, cross-cultural adaptation, and psychometric evaluation of the Persian version of the Symptom Distress Scale (SDS) in heart failure patients.

Patients with heart failure experience severe and chronic physical and psychological manifestations while the disease progresses. Assessing the degree of distress caused by manifestations of the disease in patients is the first step in designing and evaluating intervention programs to improve patients' symptoms. The aim of this study was to investigate the psychometric properties of the Persian version of the Symptom Distress Scale in HF patients. This study was conducted via methodological research design from March to November 2019. The translation process and cross-cultural adaptation were performed using a process recommended by the World Health Organization. The face and content validity and internal consistency were used to evaluate the validity and reliability of the instrument. The scale was evaluated by exploratory and confirmatory factor analysis in 300 patients with heart failure, and the obtained data were analyzed using SPSS-22 and AMOS-22 software. The content validity of the scale was approved based on the results of the study. One-factor scale with 13 items was used in the confirmatory factor analysis, and the results showed that the instrument had high goodness-of-fit indices. Spearman correlation test for convergent validity showed a correlation between the score obtained by the Scale of Symptoms of Disease and the scores of The European Heart Failure Self-care Behavior scale (9 items) (P < 0.0001). The Persian version of the Symptom Distress Scale can be used as a valid instrument for people with heart failure due to its desirable psychometric properties.

COMPORTAMENTO DE AUTOCUIDADO DE PACIENTES COM INSUFICIÊNCIA CARDÍACA: RELAÇÃO COM VARIÁVEIS SOCIODEMOGRÁFICAS E CLÍNICAS

ABSTRACT Objective: to assess self-care behavior and its relationship with the sociodemographic and clinical variables of patients with heart failure. Method: a cross-sectional and correlational study was conducted in a cardiomyopathy outpatient clinic in São Paulo, SP, Brazil. Data were collected between 2018 and 2020. The sample consisted of patients with heart failure without visual, auditory, or cognitive deficits. Self-care behavior was assessed using the European Heart Failure Self-care Behavior Scale. Sociodemographic and clinical variables were selected through a literature review. The Spearman’s correlation coefficient and the Mann-Whitney test were used for data analysis. Factors presenting p≤0.10 and the variables of clinical interest were included in the multiple analysis, and p-values ≤ 0.05 were considered significant. Results: 340 patients with a mean self-care score of 24.7 were analyzed. Those taking more medications and adhering to the pharmacological treatment tended to present improved self-care (p≤0.001). In contrast, patients without a partner (p=0.022), with a sedentary lifestyle (p&lt;0.001), or employed (p&lt;0.001) tended to present worse self-care scores. Conclusion: The factors related to self-care behavior were adherence to pharmacological treatment, the number of medications taken, marital status, employment, and sedentary lifestyle.

Clinical parameters and outcomes in heart failure patients based on gender differences

BackgroundThe increasing prevalence of heart failure poses major challenges for patients, caregivers, health professionals, and health managers. In addition to the modifiable factors affecting the disease, non-modifiable factors such as gender should be considered in the disease management. Gender differences in this field are controversial and needs to be further understood, which requires further studies. AimThis study aimed to determine the status of clinical parameters and outcomes in patients with heart failure based on gender differences. MethodsIn this analytical cross-sectional study, 115 patients with heart failure were assessed using the convenience sampling method. Data were collected from X hospital in X city, the only specialized referral center in X province, through demographic and disease-related information questionnaire, heart failure specific quality of life questionnaire, European heart failure self-care behavior scale, and medication adherence report scale. Data were analyzed using SPSS-V.21, and descriptive and inferential statistics (Chi-Square, Fishers exact test, Mann-Whitney, and Logistic regression). ResultsA relatively significant relationship was observed between the total quality of life (QoL) score and gender variable (P = 0.06), so that women had a lower quality of life than men. Medication adherence status was not significantly associated with gender variable, but its mean score was higher in women. There was a statistically significant relationship between gender and the variables of education level, marital status, living conditions, employment status, monthly income, place of residence, BMI, Hb, TG, FBS, history of DM, history of smoking, history of lower extremity edema, self-care status and the physical dimension of QoL (P ≤ 0.05). ConclusionIt is suggested that special attention should be paid in identifying patients at risk of QoL, self-care, and poor treatment adherence. It is also recommended that in the process of providing care and treatment plans for patients with heart failure, some factors be considered such as predictors from the results of the present study and also gender. Also, given that women were worse in most variables, it is suggested that this difference be considered in their assessment and care planning.

Psychometric Testing of the Chinese Version of the Self-care of Heart Failure Index Version 7.2.

Self-care is essential in patients with heart failure (HF). Our objective was to test psychometric properties of the Chinese version of the Self-care of Heart Failure Index version 7.2 (SCHFI v7.2-C). The English version of SCHFI v7.2 was translated into Chinese using the modified Brislin translation model. Psychometric tests of the SCHFI v7.2-C were performed in 320 Chinese patients with HF. Content validity, confirmatory factor analysis, convergent validity, concurrent validity, discriminant validity, internal consistency, and test-retest reliability were examined to determine validity and reliability of the questionnaire. Validity and reliability were assessed for the self-care maintenance, symptom perception, and self-care management scales. SPSS 25.0 and Mplus 8.3 were used for data analysis. Mean (SD) age of the sample was 61.2 (14.20) years. Scale content validity index ranged from 0.93 to 0.97 across the 3 scales. Results of confirmatory factor analysis supported structural validity of the 3 scales. Self-care was significantly associated with quality of life, and those with more HF experience had significantly better self-care than those with less experience, supporting construct validity. The SCHFI v7.2-C was associated with the 12-item European Heart Failure Self-care Behavior Scale. Cronbach α coefficients for the self-care maintenance, symptom perception, and self-care management scales were 0.79, 0.89, and 0.77, respectively; their test-retest reliability was 0.76, 0.78, and 0.75, respectively. The SCHFI v7.2-C is a valid and reliable instrument that can be used in Chinese patients with HF.

Effectiveness of daily activity record-based self-monitoring intervention for patients with chronic heart failure: A study protocol

BackgroundThe prevention of recurrent readmission among heart failure (HF) patients requires support for appropriate self-care behaviors to prevent exacerbation of HF and self-monitoring to allow for patients’ early perception of physical changes during exacerbations. Such support may enable patients to seek early consultation. This study developed a self-monitoring intervention that aimed at increasing the perception of patient-unique physical sensations caused by HF, based on daily activity records of patients. MethodA parallel two-arm randomized controlled trial is being conducted with 68 HF patients early after their discharge. Participants in both groups wear a wristwatch activity tracker from time-of-discharge. Participants in the self-monitoring intervention group receive support to reflect on their actual daily activities and the associated physical sensations they experienced, based on their daily activity records. The primary outcome is participants’ “Asking for Help” dimension of self-care behavior, measured using the European Heart Failure Self-Care Behavior Scale at one month follow-up after intervention. ConclusionThis study is the first trial to use an activity tracker as a tool for symptom perception among HF patients. The problem of delayed consultations during exacerbations may be resolved by assisting patients in improving their perception of their unique physical sensations associated with specific daily activities, based on their daily activity records. If the effect is clarified, it could lead to the construction of new nursing interventions for continuous disease management that aim towards re-hospitalization prevention.

In patients with chronic heart failure, there have been no gender differences in the impact of self behavior on patient-reported outcomes

Abstract Background Poor self-care behaviour is associated with a higher risk in heart failure (HF). Gender is a determinant of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL) in HF. Female gender is consistently associated with worse QoL. Whether gender may influence the effect of self-care on PROMS is not known. Purpose Describe the effect of self-care on QoL according to gender in a real world cohort of HF patients. Methods 1120 patients with chronic HF were analysed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between gender and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of global self-care and its dimensions, multivariate linear regressions models to predict QoL were constructed stratified according to gender. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value&amp;lt;0.0001). Unadjusted MLHFQ scores were consistenly higher in women compared to men (49±23 vs. 43±24; p-value&amp;lt;0.001). In adjusted GLM, female gender (F=4.8; p-value=0.028) and poor global self-care (F=12.6; p-value&amp;lt;0.001) were independent predictors of higher adjusted scores in MLHFQ, indicating worse global QoL. As shown in Figure 1, the interaction term gender by poor self-care was not significantly associated with MLHFQ scores in adjusted GLM (F=0.018; p-value=0.893): the gap between women and men in terms of QoL was observed in both self-care strata and the effect of self care on QoL was observed in both genders. Multivariate linear regresion models (Table 1) stratified according to female gender (panel A) or male gender (panel B) showed that higher scores in the EHFScBS-9 were associated with lower scores in the MLHFQ in women and men. This effect (Table 1) was equally seen in both genders for global QoL and was driven by global self-care, consulting behaviour, and in a lesser extent by autonomy-baseda dherence. The physical dimension of QoL was not affected by self-care in either women or men except for consulting behaviour. Conclusions Self-care is an independent predictor of health-related QoL in HF, regardless of the level of disease severity. Global self-care, autonomy-based adherence and consulting behaviour were particularly associated with global QoL and emotional and social dimensions of QoL in women and men. In both genders, the effect of self-care on QoL was driven by its effect on emotional and social dimensions. Provider-based adherence did not influence QoL. Funding Acknowledgement Type of funding sources: None.

Fragility influences the impact of self-care behavior on patient-reported outcomes further of psychosocial factors of self-perceived health status in patients with heart failure

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Psychosocial factors are key determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Little is known about the interplay between self-care and psychosocial factors on PROMs in HF. Purpose To describe the interaction of self-care and psycho-social factors on QoL in a real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between psychosocial factors and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of self-care, multivariate linear regressions models to predict QoL were constructed stratified according to selected psycho-social determinants. All models were adjusted by age, sex and psycho-social determinants of QoL including literacy, cognitive function (Pfeiffer test), dependency (Barthel and Lawton &amp; Brody test), social support (Duke UNC and APGAR Familyfunction), depressive symptoms (15-item Geriatric Depression Scale) and fragility (Barber test scores ≥1). Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value &amp;lt;0.0001). Fragility was present in 883 patients (79%). In adjusted GLM, poor self-care (F=10.2; p-value=0.001) and fragility (F=17.9; p-value &amp;lt;0.001) were independent predictors of higher adjusted scores in the MLHFQ indicating worse QoL. As shown in Figure 1, the interaction between fragility and self-care was significant (F=6.8; p-value = 0.009). Linear regression models (Table 1) stratified according the absence (panel A) or the presence (panel B) of fragility showed that fragility modulated the association between self-care behaviour and QoL. Only in patients without fragility, self-care were independent predictors of QoL. On the other hand, in patients with fragility, self-care behaviour did not longer influence self-perceived health status in patients with HF. Conclusions We have shown that self-care behaviour is an independent predictor of PROMs in HF regardless the presence of important psycho-social determinants of QoL only when fragility status is taken into account. Fragility modulates the influence of self-care and QoL, including each one of its dimensions. Funding Acknowledgement Type of funding sources: None.

DAMOCLES project show that cognitive function is a strong determinant of the influence of self-care behavior on health-related quality of life in patients with heart failure

Abstract Background Poor self-care is associated with a poorer outcomes in patients with heart failure (HF). Psycho-social factors are determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). However, little is known about the interplay between self-care and psychosocial factors such as cognitive function on PROMs in patients with HF. Purpose Describe the effect of self-care on QoL across cognitive function and explore whether the interaction between self-care and cognitive function may account for this effect. Methods 1120 patients with chronic HF from DAMOCLES study were analyzed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Cognitive function was evaluated using Mini-Mental State Examination (MMSE) and Short Portable Mental State Questionnaire (SPMSQ) Tests. Cognitive impairment was defined as abnormal age-and-literacy-adjusted scores. General linear models (GLM) were constructed to explore the interaction between cognitive function and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact self-care, multivariate linear regressions models to predict QoL were constructed stratified according to cognitive function. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. Lower MMSE scores (β=−0,163; p-value &amp;lt;0.001) and &amp;gt;3 errors in the SPMSQ indicating cognitive impairment (β=0.071; p-value = 0.023) were associated with higher scores in the MLHFQ. These associations were confirmed in multivariare linear regression models (β=0.062; p-value = 0.038). In adjusted GLM, poor global self-care (F=4.8; p-value = 0.029) was an independent predictor of higher adjusted scores in the MLHFQ. Interaction term poor self-care by cognitive impairment was significantly associated with MLHFQ scores (F=6.0; p-value=0.014; Figure 1). Multivariate linear regresion models (Table 1) stratified according the absence (panel A) or the presence (panel B) of cognitive impairment showed that cognitive function modulates the association between self-care behaviour and QoL. This effect was only seen in patients without cognitive impairment. In patients with cognitive dysfunction, self-care behaviour did not longer influence self-perceived health status in patients with HF. Conclusions Self-care behaviour is an independent predictor of PROMs in HF regardless cognitive disfunction. Cognitive function modulates 1) influence of global self-care and each one of its dimensions on emotional QoL and 2) impact of global self-care and consulting behaviour on global and social QoL. Funding Acknowledgement Type of funding sources: None.

In heart failure, self-care behavior is an independent determinant of health-related quality of life, regardless of the severity of this patients

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). The interplay between self-care and patient-reported outcomes such as health-related quality of life (QoL) has not been fully established. Purpose To describe the association between self-care and QoL in real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care. Scores were inverted and standardized (higher scores indicate better selfcare). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). Written informed consent, complete clinical and psychosocial information of patients were obtained at baseline. To determine the impact of global self-care and its dimensions (autonomy-based adherence, consulting behaviour and provider-based adherence), multivariate linear regressions models (backwards stepwise methods) to predict QoL were constructed. The multivariate parametric and non-parametric associations between EHFSCBS-9 scoresand the β estimated risk of impairment of QoL (defined as MLHFQ scores ≥ median values) were explored using General Additive Models (GAM). All models were adjusted by age, sex and prognostic factors such as LVEF, NYHA, NT-proBNP levels and recent hospitalization among other well-known determinants of HF severity. Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value&amp;lt;0.0001). As shown in Table 1, self-care behaviour and its 3 domains were independent predictors of QoL in 7 out of the 16 associations explored. These models confirmed a weak linear relationship between EHFSCBS-9 scores and MLHFQ scores particularly between global selfcare and consulting behaviour dimension with global, emotional and social dimensions of QoL. Interestingly, when QoL was dichotomized as impaired/preserved QoL, GAM showed a significant non-parametric “U-shape” relationship (p-value&amp;lt;0.05) between EHFScBS-9 scores and the risk of impairment in QoL (Figure 1). Conclusions We have shown that self-care behaviour is an independent predictor of health related QoL in HF regardless the level of disease severity. Global self-care and consulting behaviour were particularly and significantly associated with global QoL and emotional and social dimensions of QoL. Interestingly the relationship between self-care scores and the risk of impaired global QoL was non-linear showing a “U-shape” association pointing out that patients with extreme levels of self-care were more likely to experience impairments in QoL. Funding Acknowledgement Type of funding sources: None.

The impact of self-care behaviour on health-related quality of life across functional dependency phenotipes: insights from a real-world cohort of 1120 patients with chronic heart failure

Abstract Background Poor self-care is associated with higher risk in heart failure (HF). Self-care may influence patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Functional and instrumental autonomy are determinants of QoL. Literature has shown instrumental and/or functional dependency are associated with worse QoL. Purpose Describe the effect of self-care on QoL across to different levels of dependency and explore the potencial interaction between self-care and autonomy. Methods 1120 patients with chronic HF from DAMOCLES study were analyzed. We used modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9) to measure self-care, scores were inverted. To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional dependency for basic activities of daily living (BADL) was evaluated using Barthel index (BI). Dependency for instrumental activities (IA) was evaluated using Lawton and Brody questionnaire (LBQ). Regarding dependency, patients were grouped in 3 phenotypes: independent (normal BI and LBQ, phenotype 1), dependency for IA (abnormal LBQ, phenotype 2) and dependency for BADL and IA (abnormal BI ± abnormal LBT, phenotype 3). General linear models (GLM) were constructed to explore interaction between dependency phenotypes and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores and to obtain the estimated marginal means of QoL scores across phenotypes and levels of self-care. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value &amp;lt;0.0001). Unadjusted MLHFQ scores were consistenly higher in the phenotype 3 (51.5±21.3) compared to phenotype 2 (41.8±25.4, p-value&amp;lt;0.001) or phenotype 1 (41.6±25.6, p-value &amp;lt;0.001). In adjusted GLM, poor global self-care (F=15.7; p-value &amp;lt;0.001) was an independent predictor of higher adjusted scores in MLHFQ. Interaction term dependency phenotypes by poor self-care was not significantly associated with MLHFQ scores (F=0.297; p-value = 0.743; Figure 1): the gap in terms of QoL between self-care strata was observed across dependency phenotypes. Estimated adjusted marginal means of MLHFQ scores stratified according to dependency phenotypes and levels of self-care are displayed in Table 1. In phenotypes 2 or 3, MLHFQ scores were lower in patients with preserved self-care. In phenotype 1 differences in QoL across self-care strata were present but not significant. Conclusions Self-care behaviour is an independent predictor of health-related QoL in HF regardless of the level of patient's autonomy. Better self-care was associated with better QoL particularly in patients with dependendecy to IA and/or BADL. Impact of self-care on QoL was attenuated in patients with normal autonomy. Funding Acknowledgement Type of funding sources: None.

Correlation Between Affective Status and Self-care Behaviors in Patients with Heart Failure

Background: Poor self-care in patients with Heart Failure (HF) is directly associated with the patient’s general health getting deteriorated and hospitalized. Objectives: One of the factors influencing compliance with self-care behaviors is mood status. The aim of this study was to determine the relationship between affective status with self-care behaviors in patients with HF. Materials &amp; Methods: In this analytical cross-sectional study, 372 HF outpatients referring to a specialized heart clinic have been included using convenient sampling method. Study tools had 4 parts including demographic and social factors, the European Heart Failure Self-care Behaviors scale, and positive and negative affect scales. The collected data were analyzed using multivariate linear regression model. Results: The multivariate model adjusted for patient’s education, suffering from chronic obstructive pulmonary disease, and heart failure duration showed that positive affects (β=0.113, Standard Error (SE) =0.056, P=0.046) and negative affect (β=0.341, SE=0.053, P&lt;0.001) were significantly related to self-care behaviors, but anhedonia did not have any significant relation with self-care behaviors (β= -0.105, SE=0.097, P=0.280). The separate models accounted for 8 to 11% of the variance in the self-care behaviors. Conclusion: The result of current study indicates that patients’ mood statue including positive and negative affect are significant contributors of self-care behaviors. So, it is recommended that in addition to the patient’s physical condition, the rehabilitation program of the heart failure patients should incorporate their psychological and mental status

Self-care and quality of life among men with chronic heart failure.

IntroductionChronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.PurposeTo assess the level of self-care and quality of life among men with chronic heart failure.MethodsThe study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.ResultsThe Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).ConclusionsMen with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.

Gender-dependent compliance with therapeutic recommendations in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Non-pharmacological therapies are one of the key elements in the treatment of heart failure. Those therapies are effective if the instructions are followed. Aim of this study was the assessment of whether gender influence the degree of compliance with therapeutic recommendations in elderly patients with heart failure. Methods 180 patients (aged 72,77 ± 7,98) with heart failure recognized based on ESC criteria were included in the study. In all, capability for self-care of patients with HF were analyzed by using Polish version the nine-item European Heart Failure Self-care Behavior Scale (EHFScBS-9). The complete results are obtained by adding up the number of points – the more the points, the worse is the capability for self-care. Patients were divided into 2 groups according to the gender: 70,6% men and 29,4% women. Results A satisfactory or good level of the capability for self-care of patients with HF was found in 27,8% of the patients. More than 65% of the patients followed the recommendations for taking medication and 41,7% used a low-sodium diet, while only 5,5% of the patients followed the recommendations for physical exercise. The average value of the level of the capability for self-care of patients was 27,7 ± 5,25 points. Women significantly worse comply with the overall level of self-care (p=00441) and recommendations regarding among the following variables: "I weigh myself every day" (p=0,0342) and "I limit the amount of fluids" (p=0,0139). Exact results of EHFScBS-9 scale are presented in the table below. Conclusion Gender may be a factor in compliance with therapeutic recommendations. Women are less likely to follow therapeutic recommendations for heart failure.

Effects of remote patient management on self-care behaviour in heart failure patients: results from the TIM-HF2 trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote patient management (RPM) in heart failure (HF) patients is a rapidly developing field of digital cardiology with beneficial clinical effects. RPM might affect HF specific self-care behaviour, which represents an important patient-reported outcome. Purpose To investigate the effects of RPM used in the Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial on HF-specific self-care as a prespecified secondary endpoint analysis. Methods and Results HF patients who were recently hospitalized and do not suffer from major depression were randomized to either RPM plus Usual Care (UC) or UC only, with a 12-month follow-up. Self-reported self-care behaviour at baseline and study-end were assessed by mean differences of the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9). 1,538 HF patients (mean age 70.3±10.5 years, 70% men, 52% NYHA class II and 47% NYHA class III, 65% LVEF ≤45%) were included, obtaining 1,321 patients with valid baseline and follow-up questionnaires. Self-care behaviour sum scores increased in the RPM group (n=667) from 78.7±17 to 84.5±14 and in the UC group (n=654) from 79.0±17 to 80.0±16 from baseline to 12 months (mean difference 4.58 95% CI 3.02, 6.14; p&amp;lt;0.001). The subgroup of patients living alone and having an inadequate (&amp;lt;70) baseline self-care behaviour score showed the highest improvement (8.66[3.52; 13.81]). There were significant changes between both groups in item "I weight myself every day" (MD -1.13; 95% CI -1.24, -1.02; p&amp;lt;0.001), and item "I take my medication as prescribed" (MD -0.06; 95% CI -0.10, -0.01; p=0.014). No relation was found between the self-care behaviour score and the efficacy of RPM on the primary and main secondary endpoints of the TIM-HF2 study. Conclusions RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen. Clinical endpoints were not affected by the level of self-care behaviour.

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

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

Validation of the ELAN-HF Score and self-care behaviour on the nurse-led heart failure clinic after admission for heart failure

AimTo validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF).DesignQuantitative, prospective, single centre, cohort study.MethodsN-Terminal pro–B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days.Results88 patients were included. The median age of the study population was 75 years (IQR 69–83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08—1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 – 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99—1.03, p = 0.174).ConclusionThis study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population.Trial RegistrationThis study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.

Self-care among men with chronic heart failure - need for educational interventions?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) is one of the biggest problems in cardiology and public health. The long-term risk of developing HF symptoms in a person aged 55 years is 33% for men. Self-care is a key element of therapeutic process of patients with HF. Purpose To assess the level of self-care among men with chronic heart failure. Methods The study was conducted among 80 men diagnosed with chronic heart failure (mean age 58 years). A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9. Results Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). Conclusions Patients with HF have unsatisfactory self-care outcomes. There is a need to implement interventions based on patient-tailored health education.