Heart Failure Self-care Behaviour Scale Research Articles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Capability for self-care of patients with heart failure.

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

Effects of a Tablet Computer on Self-care, Quality of Life, and Knowledge: A Randomized Clinical Trial.

Conflicting results have been reported for telemonitoring in patients with heart failure (HF). We wanted to evaluate whether patients using a tablet computer aimed at improving self-care behavior could do so and also whether it affects quality of life and health-related quality of life, disease knowledge, and in-hospital days. Patients with HF (n = 82) were randomized to the intervention group (IG) with a tablet computer (giving information and advice) or the control group (CG) that was subject to standard care. Study was completed by 72 patients, with a mean (SD) age of 75 (8) years, 68% male, and 74% NYHA class III. Self-care behavior measured with the 9-item European Heart Failure Self-Care Behaviour Scale, health related quality of life measured by the Kansas City Cardiomyopathy Questionnaire, quality of life measured by the Swedish version of the Health Survey, knowledge measured by the Dutch Heart Failure Knowledge Scale, days in hospital, and adherence were analyzed. The IG displayed better 9-item European Heart Failure Self-Care Behaviour Scale score (median IG, 16.5 [interquartile range {IQR}, 12-22], vs median CG, 23.5 [IQR, 18.8-30.0]; P < .05) and improved health related quality of life (median IG, 72.7 [IQR, 50.8-87.9], vs median CG, 51.8 [IQR, 40.9-62.8]; P < .05). A significant difference in knowledge was seen, with an 11% increase in IG and a 1% decrease in CG (P < .05), as well as a reduction in hospital days in IG by 2.7 days per patient (relative risk, 0.72; 95% confidence interval, 0.61-0.84; P < .05). The tablet computer significantly improved self-care behavior and health related quality of life, increased HF knowledge, and reduced hospital days.

The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study.

IntroductionSelf-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited.AimsThis study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care.MethodsIn the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69±11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ).ResultsThe baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p<0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, p<0.05), lower left ventricular ejection fraction (LVEF) (per 5%, p<0.05), lower New York Heart Association (NYHA) class (class III vs class II, p<0.05). The subgroups of patients who had an initial EHFScBs total score >28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score ≤8, demonstrated the greatest potential to improve self-care during the study.ConclusionTM did not have an advantage on self-care improvement. Poor physical aspect of quality of life, lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.

Application effects of PRECEDE model in improving self-care behavior among patients with chronic heart failure

Objective To establish health promotion plan based on Predisposing, Reinforcing, and Enabling Causesin Educational Diagnosis and Evaluation (PRECEDE) model for patients with chronic heart failure, and to observe the effects of PRECEDE on the self-care ability, so as to explore the feasibility of the health education based on PRECEDE model. Methods From March 2014 to February 2015, a total of 62 patients with chronic heart failure from the geriatrics department and cardiovascular department of a Class Ⅲ Grade A hospital were selected and divided into intervention group and control group, with 31 cases in each. The patients in the control group received routine heart failure treatment and nursing intervention. On the basis of the control group, the patients in the intervention group received health promotion plan based on PRECEDE model for 3 months. European Heart Failure Self-care Behavior Scale 9 (EHFScBS-9) was applied to compare the self-care scores between the two groups. Results There was no statistical difference before intervention in the total score of EHFScBS-9 between the two groups (t=0.000, P=1.000) . The total score of EHFScBS-9 of the intervention group was lower than that of the control group after intervention and 3 months after (t=4.971, 9.156; P<0.001) . The results of repeated measurement variance analysis showed that there were time, intergroup, time and group interaction effects between EHFSCBS-9 groups (F=34.489, 40.685, 16.922; P<0.001) . Conclusions The health promotion plan based on PRECEDE model is effective and feasible, which can improve the self-care ability of patients with chronic heart failure. Key words: Self care; Chronic heart failure; PRECEDE model

Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.

The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

The Turkish Version of Reliability and Validity of Nine Item-European Heart Failure Self-Care Behaviour Scale

Amac: Bu calisma 9 maddelik Avrupa Kalp Yetmezligi Ozbakim Davranislari olceginin Turkce gecerlilik ve guvenilirliginin test edilmesi amaci ile yapildi (AKYOB-9). Materyal ve Metot: Metodolojik olan bu calisma yas ortalamasi 61,82±11,39 olan kalp yetmezligi tanisi almis 123 kalp hastasi ile yapildi. Dil adaptasyonu gecerlilik degerlendirmesi Cronbach’s alfa ic tutarlilik katsayisi ve madde toplam korelasyonu hesaplandi. Bulgular: Yapilan factor analizinde KMO indeks degeri 0,757, Bartlett’sphericityX² degeri 384,870, df: 36, p: 0,000. Cronbach’s alfa degeri 0,820 oldugu saptandi. Olcegin iki faktoru toplam varyansin %56,5’ini aciklamaktadir. Olcegin tamami icin ic tutarlilik guvenilirligi 0,820’dir. Olcegin tum factor yukleri 0,40’in ustunde ve maddelerin factor yukleri 0,511–0,817 arasinda degisiyordu. Madde-toplam korelasyonlari iki boyut icin 0,381 ve 0,639’di. Sonuc: AKYOB-9 olceginin Turkce versiyonu kalp yetmezlikli hastalarin ozbakim davranislarini olcmede kullanilabilecek guvenilir bir aractir.

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

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

Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms

Although incomplete understanding of heart failure and its signs and symptoms appears to be a barrier to successful self-care, there are few studies examining the relationship between self-care and levels of comprehensive understanding of heart failure and its signs and symptoms. To determine whether incomplete understanding of heart failure and its signs and symptoms is associated with self-care in heart failure patients who were recently discharged from the hospital due to heart failure exacerbation. Patients completed the nine-item European Heart Failure Self-care Behavior scale and questionnaire to assess knowledge of heart failure and its signs and symptoms. Three groups were formed by their different levels of understanding of heart failure and its signs and symptoms. Multivariable linear regression was used to determine whether these three levels of understanding groups predicted self-care after controlling for demographic and clinical variables. Of 571 patients 22.1%, 40.1% and 37.8% had poor, moderate, and complete understanding, respectively. Compared with patients in the poor understanding group, patients in complete and moderate understanding groups were more likely to have better adherence to self-care activities (standardized β = -0.14, 95% confidence interval -3.41, -0.47; standardized β = -0.19, 95% confidence interval -4.26, -1.23, respectively). Fewer than half of the patients had a comprehensive understanding of heart failure and its signs and symptoms, which was associated with poor self-care. Our study suggests that patient education should include contents to promote comprehensive understanding of heart failure and its symptoms, as well as the importance of self-care behaviors.

Alfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca

Introduction and objectivesHealth literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. MethodsThis prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. ResultsDisease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. ConclusionsNo association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.Full English text available from: www.revespcardiol.org/en

Effectiveness of a PRECEDE-based education intervention on quality of life in elderly patients with chronic heart failure

BackgroundOne of the most important challenges in public health is to improve the quality of life in patients with chronic heart failure (CHF). Depression, self-care capacity, and quality of life interact each other in these patients. It’s difficult to treat with general education programs and conventional therapy. PRECEDE model is a comprehensive and exclusive theory-based education programs. Its effectiveness for reducing depression and increasing quality of life has been demonstrated in patients with coronary artery bypass grafting, type 2 diabetes, and the elderly. It has not been used in elderly patients with CHF. Thus, this study aims to investigate the effects of this model on self-care behaviors, depression, and quality of life in these patients.MethodsPatients who met the inclusion criteria were randomly assigned to the intervention or control group. All the patients received conventional medical care. The patients in the intervention group also received 9 sessions of education intervention based on the PRECEDE model and then followed up for 3 months after the intervention. Data were collected before and 3 months after the intervention using 4 questionnaires, namely a PRECEDE-based questionnaire to evaluate predisposing, reinforcing, and enabling factors; the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9); the 9-item Personal Health Questionnaire (PHQ-9); and the Minnesota Living with Heart Failure Questionnaire (MLHFQ).ResultsNo significant differences were found in the mean scores for the predisposing, enabling, and reinforcing factors, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ before the intervention between the intervention and control groups. After the intervention, the scores for the predisposing, reinforcing, and enabling factors increased significantly, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ decreased significantly in the intervention group. In addition, these scores significantly differed from those of the control group. Furthermore, the MLHFQ score significantly correlated with the EHFScBS-9 and PHQ-9 scores.ConclusionThis study demonstrates a trend that PRECEDE model of health education promotion is effective in relieving depression symptoms, enhancing self-monitoring, and improving the quality of life of elderly patients with CHF.Trial registrationTrial registration number: ChiCTR-IOR-17012779; Trial registry: Chinese Clinical Trial Registry; Date registered: 22 Sep 2017; Retrospectively registered.

Adherence to guidelines in patients with chronic heart failure in primary health care

Objective: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.Design: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.Setting: Three primary health care centres in Sweden.Subjects: Patients with a CHF diagnosis registered in their medical record.Main outcome measures: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Results. The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.Conclusion: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.