Heart Failure Self-care Research Articles

Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure

AimsTo explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies...

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Self-management app usage and expectations by patients with heart failure: results of a qualitative study

Abstract Background Effective self-care in heart failure (HF) is essential to prevent acute deterioration and improve treatment adherence and quality of life. The supportive role of eHealth is becoming increasingly important to alert HF patients to changes in symptoms and take greater responsibility for maintaining or improving their state of health. Integrating the expectations, perceptions, and impression of HF patients into the design, customization, and utilization of self-care apps is crucial to ensure sustainable and beneficial implementation of such solutions. Purpose To explore patients' with HF expectations, their usage, and first impressions towards a self-care app. Methods The self-care app developed could monitor HF symptoms, provide education via e-learning modules, and telemedical services including regular checkups, recommendations, and feedback from healthcare professionals (HCP). Patients from four clinical sites in Europe, Germany (DE), United Kingdom (UK), Ireland (IRL), Netherlands (NL), who had used this app were invited to participate in a semi-structured interview. These were recorded, transcribed, and analysed by two researchers based on qualitative content analysis according to Mayring. Results In total 32 male and 6 female HF patients aged between 32 and 84 years (66±13) were interviewed (see figure 1). Average duration was 34 minutes. Most patients had used the app for 1-2 weeks at time of the interview. Most patients planned to use the app 2-3 times a week and integrate it into their daily routines. Patients expressed a preference for sessions (regular checkups, e-learnings) not to exceed 10 minutes. Patients believed features like reminders, gamification, and direct feedback from the app could positively influence their behaviour. Conversely, technical issues, too frequent data entry or repetitive questioning were perceived as negative. In case the app could give medical advice, some patients (n=12) indicated that they would only follow the app's recommendations after consulting an HCP. Overall, patients expected the app to provide continuous monitoring and an early warning system to detect and counteract deterioration at an early stage. They deemed the combination of telemedical services and patient records to be particularly valuable. Moreover, patients expected the app to serve as an information source on HF and believed it could increase their motivation and self-discipline for better self-care and therapy adherence (see figure 2). Conclusion The results show that HF patients consider eHealth apps to be valuable tools for autonomously monitoring and improving their health. However, behaviour and acceptance can be encouraged or inhibited depending on the functionalities and design of the app. The findings underline the increasing relevance of eHealth solutions, such as a self-care app in healthcare and emphasize the necessity of considering patients' needs and preferences during the development.Functions with the greatest benefit

Association between self-care behaviour and multiple frailty domains in older patients with heart failure

Abstract Background/Introduction Heart failure (HF) self-care is important for the effective management of HF, reducing clinical events such as all-cause mortality and hospitalizations. HF self-care behaviours encompass comply with a regimen involving medication, diet, and exercise, symptom monitoring, and seeking assistance when symptoms occur. Frailty, prevalent among older patients with HF, involves physical, social, and cognitive domains. Identified factors influencing self-care behaviours in patients with HF include age, social support, and knowledge of the condition. Despite research on the association between self-care behaviours and frailty, there is a notable gap in studies that explore the relationship between self-care behaviour and multiple domains of frailty, particularly with adjustments for clinical characteristics. Purpose The aim of this study was to assess the association between self-care behaviour and multiple domains of frailty in older patients with HF. Methods The study included 182 patients with HF who were aged 65 years or older. Self-care behaviour was assessed 5 months after their discharge using the European Heart Failure Self-Care Behaviour Scale (EHFScBS), a self-report questionnaire. Frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria (J-CHS) for physical frailty, and using Makizako’s five items for social frailty, and using Mini-Cog for cognitive decline. We used multiple regression analysis to assess the association between self-care score and multiple frailty domains and the number of frailty domains. The adjusted model was constructed based on age, gender, body mass index, New York Heart Association Classification, left ventricular ejection fraction, log-transformed B-type natriuretic peptide, estimated glomerular filtration rate and history of HF. In addition, we used multiple regression analysis to assess the association between the EHFScBS subitems score complying with regimen, asking for help, and adapting activities and multiple frailty domains and the number of frailty domains. Results According to the results of a multiple regression analysis, poor self-care behaviour was significantly associated with physical and social frailty and the number of frailty domains (all p < 0.05), even after adjusting for clinical characteristics. Poor complying with regimen was also significantly associated with physical and social frailty and the number of frailty domains (all p < 0.05). Poor asking for help was significantly associated with social frailty and the number of frailty domains (all p < 0.05). Conclusion The study indicates that poor self-care behaviour is linked to physical and social frailty, in addition to the cumulative number of frailty domains in older patients with HF, even when clinical characteristics are taken into consideration. This underscores the importance of factoring in the frailty status when guiding patients with HF in disease management.

The trajectory of self-care over a 12-month period in patients with heart failure, comparing those with consistently good and poor self-care

Abstract Background Self-care behaviour plays a pivotal role in enhancing the quality of life for patients with heart failure (HF) and reducing mortality and morbidity rates, but many patients struggle with suboptimal self-care behaviours. It is crucial to understand the factors influencing long-term self-care management. Purpose To assess the trajectory of self-care over a 12-month period and assess differences between patients who have constantly good self-care over a 12-month period compared to constantly poor self-care. Method This study use data from a randomised controlled intervention study, called the HF-Wii study. We included patients who had complete data on self-care during on baseline, 3, 6 and 12 months. Self-care was measured with the European Heart Failure Self-care Behaviour scale (EHFSBs). A threshold score of equal or higher than 70 was used to define self-care behaviour as good and a score lower than 70 as poor self-care. Based on literature, the following characteristics (collected from questionnaires and medical records at baseline) were considered in the analysis: age, sex, marital status, education, history of myocardial infarction, duration of HF, New York Heart Association (NYHA) functional class, LVEF, comorbidity. Other factors assessed were Health-related Quality of Life (HrQoL, Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression scale), cognition (Montreal Cognitive Assessment), sleep (Minimal Insomnia Symptom Scale) and level of HF knowledge (Dutch HF knowledge scale). Logistic regression was performed with backwards elimination of the factors considered associated with the differences between patients who have constantly good self-care at baseline, 3, 6 and 12 months compared to constantly poor self-care. Results In total, 407 patients were included in this study. At baseline, the mean self-care was 65±21, with 41% of the patients (n=245) performing good self-care. In total, 126 patients had a constantly good self-care over 12 month (31%), 120 patients had a constantly bad self-care over 12 months (30%) and 161 (39%) fluctuated in their self-care (Figure). In the multivariate analysis, patients that had continuously good self-care over 12-months were of older age (68±10 vs. 64±12, odds ratio (OR) 1.061, P-value<0.001), had higher HF knowledge (score 13±2 vs. 12±2, OR 1.439, P-value<0.001) and had higher HrQoL (score 28±20 vs 36±22, OR 0.984, P-value=0.022). compared to patients with consistently poor self-care. The variance was explained by 20%. Conclusion Younger patients with HF tend to struggle with consistent self-care over a year, underscoring the necessity for tailored interventions for this group. Conversely, patients with greater HF knowledge and higher HrQoL maintained good self-care habits.

Empowering patients with heart failure: a digital health solution improved self-care and metabolic outcomes in a randomized controlled trial

Abstract Background/Introduction Heart failure is a common cause of morbidity and mortality and poses a significant burden on patients and healthcare providers. Purpose The aim of the study was to evaluate whether a digital health program improves quality of life and clinical outcomes for patients with heart failure. Methods A single-center, randomized controlled trial (RCT) was conducted with patients receiving standard of care (SoC) at a heart failure outpatient clinic. Patients were randomized (1:1) to receive either SoC alone or SoC with an additional six-month digital health program. The program consisted of remote patient monitoring (RPM) with symptom tracking, disease-specific education, and lifestyle coaching, designed to empower patients with heart failure. After the main program concluded, a six-month maintenance program was initiated, consisting of recurrent educational materials, with reduced coaching- and RPM frequency. The primary endpoint was the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at six months. Secondary endpoints included the European Heart Failure Self-care Behaviour Scale-9 (EHFScB-9), 6-question heart failure knowledge questionnaire, and metabolic outcomes. Here we report on the Intention-to-Treat (ITT) population analysis for the primary and significant secondary endpoints at six and 12 months. Results The ITT included 175 participants, 86 in the program group and 89 in the control. Program group: mean age (SD) 64.7 (13.2), 66.3% male, 87.2% with NYHA stages I-II. Control group: mean age (SD) 66.2 (11.1) years, 69.7% male, 87.6% with NYHA stages I-II. Median compliance with RPM was 93% and in-app retention was 80% at six months. Results for primary and secondary endpoints are presented in Table 1 and Figure 1. No statistical difference was observed in the KCCQ score between groups at six or 12 months. The program group had statistically significant improvements in EHFScB-9 score at six and 12 months and in heart failure knowledge at 12 months compared to the control group. Metabolic outcomes: a significant difference in glucose levels was also observed between groups at six months, and in HbA1c and triglycerides levels at 12 months. Conclusions The difference between groups in the primary endpoint of heart failure symptoms and quality of life, as measured by the KCCQ-12, was not statistically significant. However, significant differences were observed in self-care behaviour and heart failure knowledge, as well as metabolic outcomes at six and 12 months, when compared with standard care alone. These findings, along with good retention and engagement, indicate the value to patients of digital health interventions in the management of heart failure.

The Effect of Breathing and Relaxation Exercises on Self-Care, Dyspnea, and Fatigue in Heart Failure: A Randomized Controlled Study.

Dyspnea, fatigue, and self-care are common occurrences of heart failure. This study evaluated the effects of yoga breathing and progressive muscle relaxation exercises on dyspnea, fatigue, and self-care in heart failure. The study conducted between April 2023 and March 2024 randomized 66 heart failure patients into 3 groups (yoga breathing exercise, progressive muscle relaxation exercise, and control). The intervention groups engaged in specific exercises tailored to their assigned regimen for 10minutes twice daily over a 2-week period, while the control group maintained their pharmacological treatment. At the end of the intervention (second week) yoga breathing exercise notably ameliorated fatigue, dyspnea, and self-care (P <.001), changes in saturation, heart rate, and respiratory rate favoring the intervention groups (P <.05). Yoga breathing exercises enhance self-care, alleviate fatigue, and dyspnea in heart failure. Additionally, yoga breathing and progressive muscle relaxation exercises provide benefits in regulating saturation, heart rate, and respiratory rate in heart failure.

Knowledge and self-care behavior among heart failure patients in South India

BACKGROUND: Heart failure (HF) is a chronic condition with significant public health concerns. HF necessitates adequate knowledge and adherence to self-care for enhanced quality of life and decreased rehospitalization. This study aimed to explore knowledge and self-care behavior in patients with HF. MATERIAL AND METHODS: The study was conducted in cardiology wards of a tertiary care hospital and the design was a randomized controlled trial. The baseline data (before the intervention) from 160 HF patients enrolled in a randomized controlled trial were analyzed. Knowledge and self-care behavior were measured using the Dutch HF Knowledge Questionnaire (score ranging from 0 to 15) and European HF Self-care Behavior Scale-9 (score ranging from 0 to 100). Higher scores indicated better self-care behavior and knowledge. Descriptive statistics such as frequency, percentage, mean, and standard deviation and inferential statistics such as independent sample t-test and ANOVA were performed. RESULTS: The majority (75.0%) were men with a mean age of 56.1 ± 7.9 years. A significant proportion had hypertension (65%), diabetes (58.7%), or both comorbidities (40.6%). Most exhibited a left ventricular ejection fraction &lt;30% (60.6%) and New York Heart Association class II (43.1%). The mean knowledge and self-care behavior scores were 7.1 ± 2.0 and 45.0 ± 12.4, respectively. Over half of the participants had inadequate self-care behavior (51.2%), and 88.3% lacked sufficient knowledge about HF. Medication adherence was high (87.0%) among the participants, while only 3.1% reported regular weight monitoring and 32.3% exercised regularly. CONCLUSIONS: There was a lack of HF-related knowledge and inadequate self-care behavior for HF management. Effective interventions to improve disease-related knowledge may lead to better self-care behavior and improve clinical outcomes.

Health-related quality of life and self-care in heart failure patients under telecare-insights from the randomized, prospective, controlled AMULET trial.

The growing population of heart failure (HF) patients places a burden on the healthcare system. Patient-centered outcomes such as health-related quality of life (HRQoL) and self-care behaviors are key elements of modern HF management programs. Thus, optimized strategies to improve these outcomes are sought. To assess the effects of a new model of medical telecare on HRQoL and self-care in patients with HF (the AMULET study). The study was prospective, randomized, open-label, and controlled with two parallel groups: telecare and standard care. In the telecare group, HF nurses performed patient clinical assessments with telemedical support by a cardiologist and provided education focused on the prevention of HF exacerbation. In the standard care group, patients were followed according to standard practices in the existing healthcare system. At the baseline and at 12 months, HRQoL was assessed using the Short Form 36 (SF-36) questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLwHF). The level of self-care was assessed with the 12-item standardized European Heart Failure Self-care Behavior Scale (EHFScBS-12). In the overall study group, 79% of the subjects were male, the mean age was 67 ± 14 years, and 59% of the subjects were older than 65 years of age. The majority of the subjects (70%) had a left ventricular ejection fraction below 40%. After 12 months, statistically significant increases in physical component of the SF-36 (43.3 vs. 47.4 for telecare vs. 43.4 vs. 46.6 for standard care) and mental component of SF-36 (58.4 vs. 62 for telecare vs. 60.4 vs. 64.2 for standard care) were noted, with no intergroup differences. However, patients receiving telecare showed improvement in specific domains, such as physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health. There was a significant decrease in MLwHF (29 vs. 35.0; lower is better) at follow-up for both groups. Telecare patients had a statistically significant decrease in EHFScBS-12 (lower is better) at 12 months. AMULET outpatient telecare, which is based on nurse-led non-invasive assessments supported by specialist teleconsultations, improved the HRQoL and self-care of HF patients after an episode of acute HF.

The effect of educational interventions by nurses through Orem's self-care theory on the ability of self-care in myocardial Infarction patients in public sector hospital: A quasi-experimental study.

To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction. The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21. Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05). Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

Differential impacts of self-care behavior on clinical outcomes in patients with and without recent heart failure hospitalization

BackgroundAlthough clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF). MethodsWe analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020–June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF. ResultsDuring a median follow-up period of 427 (interquartile range 273–630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029). ConclusionIn patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.

Effects of Social Isolation and Loneliness on Heart Failure Self-care: A Cross-sectional Analysis.

Patients with heart failure (HF) who engage in effective HF self-care have better quality of life, and lower risks of all-cause and HF-related hospital readmission and mortality. It is unclear whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care. The aim was to explore the relationship between social isolation, loneliness, and HF self-care. This was a cross-sectional secondary analysis (n = 49) of the GEtting iNTo Light Exercise for HF randomized controlled trial, a 6-month home-based live group gentle exercise intervention for patients with HF. Measures included the following: 6-item Lubben Social Network Scale for social isolation, Patient-Reported Outcomes Measurement Information System Social Isolation survey for loneliness, Self-Care of Heart Failure Index, and Patient-Reported Outcomes Measurement Information System Depression survey. Multiple linear regression modeling was used to examine the relationships of 4 HF self-care processes to social isolation and loneliness, adjusting for depression and grouping (control group or intervention group). Scores indicating less social isolation predicted higher self-care maintenance (B = 0.937, P = .015), monitoring (B = 0.799, P = .041), and management (B = 1.812, P < .001). Loneliness did not predict HF self-care. To our knowledge, this is the first study to predict HF self-care using distinct measures for social isolation and loneliness. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care. Prospective studies are needed to investigate causal relationships between social isolation and HF-self-care engagement to determine the effect on outcomes such as hospital readmission and mortality.

Propelling Nurse-Led Structured Intervention to Enhance Self-Care among Patients with Chronic Heart Failure (PROACT-HF): A Cluster Randomized Controlled Trial Study Protocol.

Heart Failure (HF) is a common chronic disease that has a high readmission rate and is associated with worsening symptoms and major financial impacts. Disease management implemented during or after an HF hospitalization has been shown to reduce hospitalization and mortality rates. Particularly for outpatients, it is necessary to provide self-care interventions. Structured nurse-led support such as timely follow-ups, including phone calls, is beneficial for improving self-care assessments. Evidence for nurse-led support has been investigated but is less than conclusive. The aim of this study is to compare the effectiveness of a nurse-led structured intervention for outpatients with chronic HF against the usual medical care in terms of self-care behaviors and occurrence of symptom exacerbation or rehospitalization. This is a cluster-randomized controlled trial. A total of 40 facilities with certified HF nurses will be allocated to two-arm clusters at a 1:1 ratio, randomly to the intervention or usual care arms. A total of 210 participants will be assigned from the hospital. Participants will be adults aged 18 years or older diagnosed with chronic HF who are classified as Stage C according to the ACCF/AHA Heart Failure staging system. In the intervention group, patients will receive structured nursing support. This begins with weekly support, including phone calls, for the first month, then transitions to monthly support thereafter. The aim is to ensure the stability of their living conditions, promote medication adherence, and encourage self-management. In the control group, patients will receive the usual care. Primary outcomes will assess the improvement or continuation of self-care behavior as measured by changes in EHFScBS (European Heart Failure Self-Care Behavior Scale) scores. Secondary outcomes include occurrence of readmission within 30 days, 3 months, 6 months, and 1 year after discharge, duration of home care until readmission, and blood levels of BNP and NT-proBNP.

Influence of Neighborhood Disadvantage and Individual Sociodemographic Conditions on Heart Failure Self-care.

Residence in socioeconomically disadvantaged neighborhoods and individual sociodemographic conditions contribute to worse heart failure (HF) outcomes and may influence HF self-care. However, associations between neighborhood disadvantage, socioeconomic conditions, and HF self-care are unclear. The purpose of this secondary analysis was to investigate whether neighborhood disadvantage and individual socioeconomic conditions predicted worse HF self-care. This study was a secondary analysis of baseline data from a mixed-method study of 82 adults with HF. Participant zip codes were assigned a degree of neighborhood disadvantage using the Area Deprivation Index. Those in the top 20% most disadvantaged neighborhoods (Area Deprivation Index ≥ 80) were compared with those in the least disadvantaged neighborhoods. The Self-Care of Heart Failure Index was used to measure self-care maintenance and monitoring. Multiple linear regression was conducted. Of all participants, 59.8% were male, 59.8% were persons of color, and the mean age was 64.87 years. Residing in a disadvantaged neighborhood and living alone predicted worse HF self-care maintenance and monitoring. Having no college education was also a predictor of worse HF self-care maintenance. Although persons of color were more likely to reside in disadvantaged neighborhoods, race was not associated with HF self-care. Residing in a disadvantaged neighborhood and living alone may be important risk factors for worse HF self-care. Differences in self-care cannot be attributed solely to the individual sociodemographic determinants of race, gender, age, annual household income, or marital status. More research is needed to understand the connection between neighborhood disadvantage and HF self-care.

Generic and disease-specific self-care instruments in older patients affected by multiple chronic conditions: A descriptive study.

To describe and compare generic and disease-specific self-care measures in patients with multiple chronic conditions (MCCs) in the three dimensions of self-care maintenance, monitoring, and management. Multicentre cross-sectional study. Patients aged 65 and over with MCCs. We used Self-Care of Chronic Illness Inventory to measure generic self-care, Self-care of Diabetes Inventory to measure self-care in diabetes mellitus, Self-Care of Heart Failure (HF) Index to measure self-care in HF, and Self-Care of Chronic Obstructive Pulmonary Disease Inventory to measure self-care in chronic lung diseases. We recruited 896 patients. Multimorbid patients with diabetes had lower scores on the self-care maintenance scale, and diabetic patients in insulin treatment on the generic management scale than on the disease-specific instrument. Multimorbid patients with HF or chronic lung diseases scored higher on generic self-care maintenance and monitoring scales than disease-specific ones. There was a partial consistency between the generic and disease-specific self-care maintenance and management. Inadequate behaviours were recorded in disease-specific self-care monitoring rather than generic ones. Older patients affected by MCCs scored differently in the generic and disease-specific instruments, showing inadequate self-care in some of the three self-care dimensions. The choice between generic and disease-specific instruments to use in clinical practice and research should be made considering the specific aims, settings, patients characteristics, and knowledge of the different performance of the instruments by users. No study has described and compared generic and specific self-care measures in patients affected by MCCs. Knowing these differences can help nurses choose the most suitable measure for their aims, context, and patients and plan generic and disease-specific self-care educational interventions for those behaviours in which MCCs patients perform poorly. Patients were informed about the study, provided informed consent, and answered questionnaires through interviews.

Patients with Heart Failure: Internet Use and Mobile Health Perceptions.

Heart failure is a complex clinical syndrome noted on approximately one in eight death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders. We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care. Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey. Over 50% of the patients had utilized the internet to search for heart failure information in the past 12 months, experience using health-related apps, and thoughts that an activity tracker or smartwatch could help them manage heart failure. Qualitative analysis of the interviews revealed six themes: trust in their physicians, alternatives to mobile health apps, lack of need for mobile health devices, financial barriers to activity tracker and smartwatch ownership, benefits of tracking and reminders, and uncertainty of their potential due to lack of knowledge. Trust in their physicians was a major factor for heart failure patients who reported not searching for health information on the internet. While those who used mobile health technologies found them useful, patients who did not use them were generally unaware of or unknowledgeable about them. Considering patients' preferences for recommendations from their physicians and tendency to search for heart failure information including treatment and management options, patient-provider discussions about mobile health may improve patient knowledge and impact their usage.

Psychometric analysis of the kansas city cardiomiopathy questionnaire-23 in a european population

Abstract Background People affected by heart failure (HF) often exhibit poor quality of life, which places a great deal of burden on the healthcare systems. The Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 is one of the most widespread instruments to measure quality of life in this population. So far, its psychometric properties have been investigated by a broad array of research, but the overall findings reveal inconsistency of the factorial structure and lack of rigorous psychometric testing. Objective The aim of this study was to evaluate the psychometric properties of the KCCQ-23 in a European cohort of HF patients. Methods The data used for this study were collected for the MOTIVATE-HF study, which was a three-arm, multicenter, randomized controlled trial to evaluate the effect of motivational interviewing for improving self-care in HF. A group of 510 patients (median age 74 years, IQR=18, 58% males) completed the KCCQ-23 along with clinical and psychosocial measures. Factorial validity was established with confirmatory factor analysis (CFA); omega and model-based internal consistency indexes were computed to examine the internal consistency of the scale. Convergent validity was established by correlating the KCCQ-23 scores with several clinical and psychosocial measures. Measurement invariance testing was conducted within a multigroup framework across patients with preserved vs those with reduced ejection fraction. Results Two CFA solutions were tested, which confirmed the theoretical and empirical models postulated by the original author. The internal consistency coefficients for the latent dimensions were adequate (Omega range =0.77-0.93; internal consistency coefficient =0.89-96)- KCCQ-23 scores were found to be correlated with ejection fraction, NYHA levels, quality of life, self-care confidence, anxiety and depression, and symptom burden, supporting its convergent validity. Finally, the KCCQ-23 was invariant across ejection fraction levels, both in the theoretical and empirical factor solution. Conclusion Overall, this study provides for the first time evidence that the KCCQ-23 has satisfactory psychometric properties, promoting its use in clinical settings and research to investigate the quality of life in patients with HF.

Impact of reduced ejection fraction on affect, cognition and self-care behaviors in adults with heart failure

Abstract Introduction In response to the escalating complexity of clinical care for individuals with heart failure, there is a growing need for in-depth investigations. This study investigated the influence of ejection fraction (EF) on affective symptoms (i.e. anxiety and depression), cognitive function, and self-care behaviors in adults with heart failure. Aim The primary aim of this study was to compare affective symptoms, cognitive function and self-care behaviors between adults who had heart failure with reduced EF (HFrEF: EF≤40%) and adults who had heart failure with preserved EF (HFpEF: EF&amp;gt;40%). The secondary aim was to explore differences in the relationship between cognitive function and self-care behaviors. Material and Methods Participants in this cross-sectional study were recruited from heart failure clinics in Wroclaw, Poland between 2022 and 2023. Comprehensive clinical characteristics, including EF, were extracted from the medical record. Participants completed a survey that included reliable and valid measures of affective symptoms (Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9)), cognitive function (i.e. the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE)), and self-care behaviors (self-care of heart failure index). Results The study included a total of 250 participants with heart failure: 145 (58%) had HFrEF and 105 (42%) had HFpEF. Patients with HFrEF were younger (71.1±6.2 years) than those with HFpEF (73.0±7.0 years; p=0.011). There were fewer women with HFrEF (n=16 (15.2%)) than HFpEF (n=61 (42.1%); p&amp;lt;0.001). There were no statistically significant differences in affective symptoms, cognitive function or self-care behaviors comparing adults with HFrEF vs. HFpEF (all p&amp;gt;0.05). Overall, worse cognitive function was associated with worse self-care based on the MMSE (r=-0.20, p=0.001) but not the MoCA (r=-0.12, p=0.056). Conclusion Although there were no affective, cognitive, or self-care behavioral differences between adults with HFrEF and HFpEF, age and gender differences between these groups must be considered in clinical care. Additionally, cognitive dysfunction, especially as measured by the MMSE, must serve as a red flag for poor self-care in heart failure irrespective of EF.

A study to determine if the fluid heart tracker app supports patient decision-making at the onset of worsening heart failure

Abstract Background Delay in seeking early intervention for worsening heart failure (HF) can result in poorer patient outcomes, hospital admission and increased risk of mortality (Andersen 2017, Matsue et al. 2017, Mikami et al. 2021). Despite the availability of health-related mobile apps for HF self-care, no study has focused on whether apps designed for HF weight monitoring make a meaningful contribution to the decision-making process of HF self-care. The Fluid Heart Tracker App was developed as a simple app to support the patient in the identification of significant weight gain as a result of worsening HF. An Advanced Nurse Practitioner in HF proposed the concept of the app, and it was developed by an Open-Source Volunteer team. It has one feature which is weight monitoring. It does not require interpretation of symptoms. The app has CE approval. It does not have a backend. The Irish Heart Foundation (IHF) has championed the app and the National Heart Programme listed it as a patient resource in the National Model of Care for Heart Failure in Ireland. The app is free to download from play store and the app-store in Ireland and the UK. Pilot study An evaluative, cross-sectional pilot study was initially carried out in potential users from three acute general hospitals. to determine the acceptability and usefulness of the Fluid Heart Tracker-App for patients with HF. This to garner feedback to use to develop, alter or refine the app. Methods Participants downloaded the app and used it to monitor their daily weight for two weeks. A short bespoke questionnaire was developed for the survey. It comprised five valid questions with dichotomous answers and an option at the end for participants to add any additional six comments. Results 31 participations- 13 female. The average age was 72. All participants (N=31, 100%) used the app, found it useful and found it easy to use and all participants would recommend the app to other patients with heart failure. 30 participants used the app daily, while one used it on alternate days. Participants stated that it was easy or very easy to use. Based on these positive results a before and after, quasi-experimental study is currently being undertaken. Aim of current study The aim of this current study is to determine the impact, use and the effect of the Fluid Heart Tracker App on patient decision making in HF. Primary Outcomes 1) Compare if using the app improved previous engagement patterns for weight monitoring. 2) Determine which factors influence engagement with the app. 3) Determine the impact of an app alert to the patient on seeking medical attention for worsening heart failure. Progress to date 179 participants were recruited from 12 HF sites in Ireland. Data collection was completed November 2nd, 2023. Currently the data set is being cleaned prior to statistical analysis. This investigation has been undertaken as part of a PhD study.

Supportive care improves self-care management and knowledge of patients with heart failure and diabetes mellitus

Abstract Introduction Heart failure (HF) and diabetes mellitus (DM) most of the times occur together, aggravating patients’ outcomes and the interaction of the two conditions, which is complex, make the application of effective management programs necessary, in order to improve patients’ outcomes. Purpose The aim of the current study was to evaluate the effectiveness of an individualized supportive care management program in patients with HF and DM, in order to improve patients’ self-management compared to the ‘usual’ care. Methods The current study is a sub-analysis of the randomized clinical trial named ‘SupportHeart’ using pragmatic methodology. It was consisted by the intervention group (IG) and the control group (CG). The study investigated the patients for a period of one year at 5 time points (in baseline, 1 month, 3 months, 6 months and 1 year). Self –care management was measured with the Greek versions of two tools: the ‘Self-care of Heart Failure Index’ (Gr-SCHFI) and the ‘European Heart Failure Self-Care Behavior Scale’ (Gr9EHFScBS). Linear Mixed Models Effects (LMME) were also used. Results The sample consisted of 121 patients with HF and DM and 66% were male patients. The Linear Mixed Model results have shown that there was a statistically significant effect of the intervention at all the time points after the intervention p &amp;lt; 0.001 in all the dimensions of the SCHFI; in the dimension of maintenance [1 month=2.6 (0.81, 4.4) p= 0.005, 3 months = 5.2 (3.4, 7.1) p &amp;lt; 0.001, 6 months = 8.1 (6.2, 10) p &amp;lt; 0.001, 1 year = 7.5 (5.7, 9.4) p &amp;lt; 0.001], on the management [1 month = 4.1(2.8, 5.4) p &amp;lt; 0.001, 3 months = 5.1 (3.8, 6.4) p &amp;lt; 0.001, 6 months = 7.5 (6.1, 8.9) p &amp;lt; 0.001, 1 year = 10 (8.7, 11) p &amp;lt; 0.001 and on the self-confidence [1 month =4.9 (3.4, 6.5) p &amp;lt; 0.001, 3 months = 7.8 (6.2, 9.4) p &amp;lt; 0.001, 6 months = 8.5 (6.9, 10) p &amp;lt; 0.001 and in 1 year = 9.1 (7.5, 11) p &amp;lt; 0.001]. The Linear Mixed Model results showed also a statistically significant effect of the intervention at all the time points after the intervention p &amp;lt; 0.001 in all the dimensions of the GR9EHFScBS: in the dimension of adhering to recommendations [1 month=1.5 (0.71, 2.3) p &amp;lt; 0.001, 3 months = 1.4 (0.59, 2.3) p &amp;lt; 0.001, 6 months=1.6 (0.69, 2.4) p &amp;lt; 0.001, in 1 year = 4.3 (3.5, 5.1) p &amp;lt; 0.001], on the fluid and sodium management [1 month = 2.3 (1.3, 3.2) p &amp;lt; 0.001, 3 months = 3.6 (2.6, 4.6) ) p &amp;lt; 0.001, 6 months = 4.5 (3.5, 5.5) p &amp;lt; 0.001, in 1 year = 6.4 (5.4, 7.4) ) p &amp;lt; 0.001 and on the physical activity and recognition of deteriorating symptoms [1 month = 2.6 (1.7, 3.6) p &amp;lt; 0.001, 3 months = 3.4 (2.4, 4.3) p &amp;lt; 0.001, 6 months = 3.9 (2.9, 4.9) p &amp;lt; 0.001, 1 year = 5.8 (4.8, 6.7) p &amp;lt; 0.001]. Conclusion Supportive care seems to be a promising concept for HF-DM management programs. The pragmatic methodology that was used in the research study has an intensive intervention which started rapidly and in early stages, on a person-centred basis.