Heart Failure Self-care Research Articles

Assessing Heart Failure Self-management Knowledge Through Vignettes.

Heart failure (HF) self-care is key to managing symptoms, but current HF knowledge instruments are at risk for social desirability bias (ie, tendency to respond in a way that is viewed favorably). Vignettes may be a useful method to mitigate this bias by measuring knowledge via scenarios in which individuals with HF are invited to respond to fictional characters' self-management problems rather than disclosing their own practices. The aims of the study were to develop and test the content validity of vignettes measuring individuals' knowledge of HF symptom self-management. The study had 3 phases. In phase 1, two vignettes were developed. One focused on psychological symptom self-management (ie, anxiety, depression), and the other focused on physical symptom self-management (ie, edema, fatigue). In phase 2, the research team and lay experts made improvements to the vignettes' readability. In phase 3, five HF self-care nurse experts evaluated the vignettes' clarity and importance with a 3-point Likert-type scale using Delphi methods. We calculated the vignettes' content validity using the scale-level content validity index. The final content validation encompassed 2 Delphi rounds (phase 3), yielding a scale-level content validity index of 0.92 and 0.94 for the psychological and physical symptom vignettes, respectively. These results indicate excellent initial content validity. The content of vignettes measuring individuals' knowledge of HF symptom self-management is valid based on the opinions of nurse experts. The vignettes offer a promising method to assess knowledge about HF self-care management without the pressure of disclosing individual patient practices.

Dyadic relationships between informal caregivers and older adults with chronic heart failure: A systematic review and meta-synthesis.

To synthesise the qualitative evidence on dyadic relationships between informal caregivers (ICs) and older adults with chronic heart failure (HF). A systematic review and meta-synthesis were conducted. Eight databases were searched for English peer-reviewed studies and grey literature published from inception to 27 February 2024. Qualitative and mixed-method studies involving older adults ≥ 55 years old with chronic HF and discussing patient-caregiver relationships in community settings were included. Data were synthesised using Sandelowski and Barroso's 2-step framework. A meta-summary was developed using thematic analysis, and findings were synthesised using the Theory of Dyadic Illness Management. Twenty-four studies from 2008 to 2024 were included (n = 580 participants). The meta-summary consisted of four themes and nine subthemes: (1) Characteristics of dyad relationships, (2) How both parts of the dyad care for each other, (3) Chronic HF and dyad relationships, (4) Knowledge of managing chronic HF. These were reorganised into the meta-synthesis: dyadic appraisal, dyadic management behaviours, dyadic health, contextual factors affecting dyadic relationships and management behaviours, and illness management as a dyadic phenomenon. Investigating relationship dynamics and their impact on dyads and chronic HF self-care is vital. Where possible, healthcare providers should prioritise dyadic care when caregivers are involved and deliver individualised care to improve patient and caregiver outcomes. Assessing and optimising dyadic relations, addressing individual perceptions and needs as part of clinical care, and before implementing self-care interventions in research may help ensure that self-care is appropriately tailored and would not be hindered by relationship conflicts.

Effectiveness of a Smartphone App-Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial.

Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app-based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean -1.3, SD 2.1 vs mean -0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app-based self-care strategies and feedback for patients with HF. ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000.

The Development and Testing of the Hippocratic Heart Failure Self-Care Scale.

The adoption of self-care behaviors among patients with congestive heart failure (CHF) is essential for the management of their health condition. However, there is a lack of tools for estimating self-care in CHF patients. We aim to develop and validate the Greek version of the Hippocratic heart failure self-care scale (HHFSCS). The scale includes 22 items which are reviewed by a committee of experts. Individuals indicate the frequency at which they follow each self-behavior on a five-point Likert scale. Adult patients with CHF (n = 250) from a General Hospital in Athens participated in the study from June 2020 to March 2021. Reliability coefficients and an explanatory factor analysis (EFA), using a Varimax rotation and the principal component method, were used to assess the psychometric measurements. The Cronbach's alpha coefficient of the HHFSCS was 0.807. The exploratory factor analysis identified two domains that accounted for 88.44% of the variance in the scale items; however, each sub-scale could not be used as an independent scale. Finally, the test-retest showed a significant and strong correlation (r = 0.973, p < 0.001). The HHFSCS is a reliable and valid tool for assessing self-behaviors in CHF patients. Health professionals can use it in their clinical practice to improve the management of a patient's health conditions.

Empowering self-management: exploring self-care practices in heart failure patients

Background and Aim: Heart failure (HF) is a complex clinical syndrome in which ventricular filling and beating functions are impaired. HF also causes psychosocial and economic problems and is a significant public health problem affecting the quality of life. Effective self-care (SC) is a non-pharmacological method that contributes to treatment, improves the patient's quality of life, and reduces repeated hospitalizations and economic burdens. Our study aimed to evaluate self-care in HF patients and to determine the factors affecting SC.&#x0D; &#x0D; Materials and methods: A total of 100 patients with HF, including 36 women and 64 men, were included in the study. Data were collected by using the Descriptive Information Form and the European Heart Failure Self-Care Behavior Scale in one-on-one interviews with patients under appropriate physical conditions.&#x0D; &#x0D; Results: Our findings indicate that a range of factors, including age, hypertension, educational status, the total number of comorbid diseases, and the use of certain medications such as SGLT-2 inhibitors, differently impact SC behaviors. SC behaviors were found to be adequate in the study population&#x0D; &#x0D; Conclusion: We identified essential factors that affect SC in HF patients. We have identified critical factors such as age, educational status, hypertension, comorbidity, and particularly the use of SGLT2 inhibitors, as key influencers of SC practices. For this reason, patient-centered healthcare models should be developed and considered by medical practitioners.

Advances in the Science of Heart Failure Self-care.

Advances in the Science of Heart Failure Self-care.

Individual and systems-related factors associated with heart failure self-care: a systematic review

BackgroundHeart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 – Dec 2021) using the Socioecological Model as a review framework.MethodsAn experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review.ResultsA subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level.ConclusionResearchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review.

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47–13.43), illiteracy (AOR: 2.64, 95% CI: 1.52–6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21–3.61), and taking five or more medications (AOR: 1.83, 1.01–3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

Development and validation of the self-volume management behaviour questionnaire for patients with chronic heart failure.

We aim to develop and validate a questionnaire on the behaviour of self-volume management of patients with chronic heart failure. Based on the specific situation theory of heart failure self-care, the items of this questionnaire were formed through literature review and expert consultation. Content validity is judged by expert consultation. Item analysis was used for further filter entries. Cronbach's alpha and retest were used for reliability. Exploratory factor analysis and confirmatory factor analysis were used to test the structural validity. The questionnaire finally contained 3 subscales and 22 items. The Cronbach's α was between 0.732 and 0.797. The reliability of the retest was between 0.983 and 0.998. In expert consultation, the I-CVI of each item was 0.92-1, and the S-CVI of each subscale was 0.99, 1.00, and 0.99. In exploratory factor analysis, each subscale has two factors. In confirmatory factor analysis, the model fits of the three subscales were good: χ2/df<3, RMSEA<0.08, CFI>0.9, TLI>0.9, and SRMR<0.05. The study has shown that the questionnaire on the behaviour of self-volume management of patients with chronic heart failure has good reliability and validity. It can be used as an evaluation tool for evaluating the self-volume management behaviour of patients with chronic heart failure.

Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment.

Postpartum quality of life (QoL) in women with heart disease has been neglected. To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns. The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression. This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525). Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis.

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool. In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security. The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed. ClinicalTrials.gov: NCT04955600.

Self-Perceptions Of Lifestyle Changes During Covid-19, Adherence To Heart Failure Self-Care Behaviors And Their Association With Heart Failure-Related Quality Of Life

Self-Perceptions Of Lifestyle Changes During Covid-19, Adherence To Heart Failure Self-Care Behaviors And Their Association With Heart Failure-Related Quality Of Life

Autocuidado de pessoas com Insuficiência Cardíaca: a importância da telenfermagem na pandemia da COVID-19

Abstract Objective: to describe factors of influence of telenursing on naturalistic decision making about self-care of people with heart failure during COVID-19. Method: this is a descriptive study with a qualitative approach, with 16 participants interviewed after hospitalization for decompensated heart failure. The data was collected using audio and video technology and submitted to content analysis, guided by the Situation-Specific Theory of Heart Failure Self-Care. Result: two thematic categories emerged from the analysis: Self-care as a decision-making process and Factors influencing decision-making, which describe tele-nursing as a support resource for people with heart failure, during changes in care in the pandemic period. Conclusion: it was possible to understand the relationship between telenursing and the establishment of a bond, in order to stimulate naturalistic decision-making by people with heart failure in their daily lives in a coherent way, leading to better health outcomes.

Factors associated with medication non-adherence among patients with heart failure.

to identify the factors contributing to medication non-adherence among patients with heart failure. cross-sectional and analytical study using the Medida de Adesão ao Tratamento [Treatment Adherence Measure] scale to assess medication non-adherence. Independent variables were collected using the European Heart Failure Self-care Behavior Scale and an instrument developed by the authors based on a previous study. Statistical tests were implemented to analyze data with p≤0.05 statistical significance. the sample comprised 340 patients, with 9.4% considered non-adherent. The multiple analysis results showed that one unit increase in an individual's self-care score led to an 8% increase in the prevalence of non-adherence; patients with a family income above three times the minimum wage presented a prevalence of non-adherence equal to 3.5% of the prevalence of those with up to one times the minimum wage; individuals consuming alcohol or with depression presented 3.49 and 3.69 times higher prevalence of non-adherence, respectively, than individuals not presenting such history. medication non-adherence was associated with self-care, family income, depression, and alcohol consumption.

Comparing the Effects of Face-to-Face and Virtual Self-Care Training Methods on Self‐Care and Quality of Life among Patients with Heart Failure: A Randomized Clinical Trial Study

Background and Objective: Heart failure is one of the most common chronic, progressive, and debilitating heart disorders, exerting a destructive effect on self-care and quality of life in these patients. The present study aimed to compare the effects of face-to-face and virtual self-care training methods on self‐care and quality of life among patients with heart failure. Materials and Methods: This three-group clinical trial study was conducted on 120 patients with heart failure admitted to Farshchian Hospital in Hamadan. The samples were selected via the available sampling method and assigned to three groups (control, virtual, and face-to-face education) using permuted block randomization. Demographic characteristics form, European Heart Failure Self-care Behaviour Scale (EHFScBs), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were completed by self-report before the intervention. The control group received only the routine training of the clinic, while the face-to-face training group received self-care training in four one-hour group sessions, one day apart. The virtual group received the same amount of education in the form of educational clips, and two months after the intervention, the questionnaires were completed. Chi-square tests, Fisher's exact test, paired t-test, and one-way analysis of variance were used to analyze the data. Results: The results pointed out that before the intervention, there was no statistically significant difference between the demographic variables, self-care, and quality of life of patients in the three groups (P&gt; 0.05). After the intervention, no statistically significant difference was observed between the virtual and face-to-face training groups in terms of self-care and quality of life (P&gt;0.05). Nonetheless, self-care and quality of life were improved in these two groups compared to the control group (P˂0.05). Conclusion: Both virtual and face-to-face training methods had the same effect on self-care and quality of life. Virtual training is a great alternative to face-to-face training in the absence of necessary conditions.

Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission

Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem. To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization. This randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022. Participants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team. The primary end point was change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed. Of 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, -2.21; 95% CI, -3.67 to -0.74; P = .001; score difference at 180 days, -2.08; 95% CI, -3.59 to -0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26). An intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome. ClinicalTrials.gov Identifier: NCT04062461.

Effects of nurse-led self-care interventions on health outcomes among people with heart failure: A systematic review and meta-analysis.

To estimate the effects of nurse-led self-care interventions on people with heart failure (HF). Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant. A systematic review and meta-analysis of randomised controlled trials (RCTs). Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies. RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA. Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50-1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49-2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24-1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear. Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review. The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.

Investigating the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients.

Self-care behaviors, which have a vital role in the management of heart failure disease, are influenced by several factors that are of paramount importance. This study aimed to determine the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients. This descriptive-analytical study was conducted from July to September 2021 on 203 patients with heart failure. Samples were selected by convenience sampling method from six centers in Ahvaz city. Data were collected using a clinical-demographic information questionnaire, the European Heart Failure Self-care Behavior Scale (EHFScBs), the Multidimensional Scale of Perceived Social Support (MSPSS), the 12-Item Short Form Health Survey (SF-12), and Paloutzian and Ellison's Spiritual Well-being Scale. Data analysis was performed with SPSS 16 using descriptive and analytical statistical methods including Pearson's correlation coefficient, regression analysis, independent t-test, and analysis of variance. The mean and standard deviation of the age of the female and male participants were 63.54 ± 14.03 and 62.34 ± 13.79, respectively. The majority of the participants (54.2%) were female, had primary education (23.2%), and were married (82.8%). Statistically significant relationships were observed between perceived social support and self-care (r = -0.22, P < 0.01), between spiritual health and self-care (r = -0.39, P < 0.01), and between the quality of life and self-care (r = 0.62, P < 0.01). However, no such relationship was found between demographic characteristics and self-care. Considering the predictive role of spiritual health, social support, and quality of life in self-care behaviors, it is necessary for planners to pay special attention to these factors when designing educational-supportive programs for these patients.

Effect of Daily Activity Record-Based Self-monitoring Intervention on the Perception of Physical Sensations in Patients With Chronic Heart Failure: A Randomized Controlled Trial.

To prevent rehospitalization for heart failure (HF), patients need to be able to perceive physical changes that occur at the onset of HF exacerbation and seek early help. The aim of this study was to evaluate the effect of a self-monitoring intervention on patients' perceptions of physical sensations during daily activities in the context of HF via a randomized controlled trial. Participants (N = 70) were randomly assigned to the intervention (received daily activity record-based self-monitoring intervention support; group A) or control (only explained the measured results from the records; group B) group. Group A reflected on and described the physical sensations in their daily activities within 1 month after discharge. Outcome measures were assessed at 1 month after the intervention using the European Heart Failure Self-care Behavior Scale, Evaluation Scale for Self-Monitoring by patients with Heart Failure, clinical events, physical activity, and sleep. There was no significant difference in the change in the "asking for help" subscale score of the European Heart Failure Self-care Behavior Scale between the groups (+0.7 vs +0.4 points, P = .716). Group A had improved score on the self-monitoring subscale related to "concern about how movements affect body" from baseline (from 12.7 to 14.0 points, P = .026). There was no significant effect of self-monitoring intervention support on the first rehospitalization related to HF and all-cause death (log-rank χ 2 = 0.432, P = .511). A significant difference in moderate-intensity physical activity between the groups was observed (+4.6 vs -0.5 minutes, P = .029). A focused strategy that enables patients to perceive their physical sensations and promotes early help-seeking behavior is needed.