Heart Failure Self-care Research Articles

Abstract 11819: Self-Care Adherence and Related Factors in Koreans With Heart Failure

Introduction: Self-care is pivotal in managing heart failure (HF). However, patients’ adherence to self-care and associated factors are not fully understood in Koreans with HF. The aim of this secondary analysis was to assess the level of adherence to self-care and to identify associated factors in patients with HF. Methods: We analyzed baseline data from 122 HF patients (mean age 66.22 [SD 13.58] years; 50.8% female) enrolled in a randomized controlled trial. To determine adherence to self-care behaviors, the proportion of patients answering “completely agree” or “agree” to each item in the European self-care behavior scale (EHFScBS) was calculated. Based on the situation-specific theory of HF self-care, we investigated the effects of person-related factors (i.e., age, sex, socioeconomic status, health literacy, and self-efficacy), problem factors (i.e., multimorbidity, physical functioning, and depression), environmental factor (i.e., social support), and knowledge on adequate self-care (EHFScBS score ≥ 70) using logistic regression analyses. Results: The mean EHFScBS score was 58.29 (SD 19.23), and 34 patients (27.9%) reported adequate self-care. The adherence rate was lowest for fluid restriction (25.4%) and low salt diet (36.1%). Self-care confidence, depressive symptoms, and social support were significantly associated with adequate self-care in univariate analyses (Table 1). After adjusting for other factors, higher levels of self-care confidence (adjusted odds ratio 1.03, p =.004) and lower levels of depressive symptoms (adjusted odds ratio 0.89, p =.03) were significant factors for adequate self-care. Conclusions: Efforts are needed to help patients with HF to engage in self-care practice. Self-care interventions should focus on promoting self-care confidence and reducing depressive symptoms in patients with HF. Routine assessment of self-care confidence and depressive symptoms may help clinicians to identify high-risk patients.

Abstract 15451: Using Fitbit Measured Activity Levels as an Indicator of New York Heart Association (nyha) Functional Class

Introduction: Commercially available wearable devices for physical activity (PA) monitoring may provide objective data to facilitate assessment of NYHA class in patients with heart failure (HF). However, there is limited research exploring their ability to differentiate patients between NYHA classes. Objective: This study aims to assess the relationship between NYHA class and PA using a Fitbit wrist-based activity tracker (Charge 3) in patients with HF. Methods: We conducted a secondary analysis of baseline NYHA and PA data (daily step count and minutes of moderate-to-vigorous PA [MVPA]) collected by the iCardia4HF trial, which examined the feasibility and preliminary efficacy of a mHealth intervention for HF self-care. NYHA class was determined by a trained research assistant at the baseline visit, using standardized criteria. Daily steps and MVPA minutes were measured using Fitbit data from the first 7 days after the baseline visit. To be included in the analysis, patients had to have ≥4 days with ≥600 minutes of Fitbit wear-time/day. Results: We analyzed data from 78 participants (mean age=55.2 years [SD 10.6]; female=43.6%; Black/African American= 79.5%; mean BMI=35.6 kg/m2 [SD 8.7]; HFrEF=65.4%). The Kruskal-Wallis test demonstrated significant differences in the distribution of daily steps (p=.021) and MVPA (p=.023) across NYHA classes. Pairwise comparisons showed that patients in NYHA Class III had significantly lower daily steps and MVPA minutes than patients in Class I. There were also important differences in daily steps and MVPA between patients in NYHA Class III and II, and Class II and I, but these did not reach statistical significance. Conclusions: There was a general decrease in steps and MVPA duration with increasing NYHA class. Wrist-worn activity trackers represent a promising method for estimating NYHA class and assessing HF severity and progression through continuous PA monitoring, but larger studies are needed for validation.

Characteristics of Smart Health Ecosystems That Support Self-care Among People With Heart Failure: Scoping Review.

The management of heart failure is complex. Innovative solutions are required to support health care providers and people with heart failure with decision-making and self-care behaviors. In recent years, more sophisticated technologies have enabled new health care models, such as smart health ecosystems. Smart health ecosystems use data collection, intelligent data processing, and communication to support the diagnosis, management, and primary and secondary prevention of chronic conditions. Currently, there is little information on the characteristics of smart health ecosystems for people with heart failure. We aimed to identify and describe the characteristics of smart health ecosystems that support heart failure self-care. We conducted a scoping review using the Joanna Briggs Institute methodology. The MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, and ACM Digital Library databases were searched from January 2008 to September 2021. The search strategy focused on identifying articles describing smart health ecosystems that support heart failure self-care. A total of 2 reviewers screened the articles and extracted relevant data from the included full texts. After removing duplicates, 1543 articles were screened, and 34 articles representing 13 interventions were included in this review. To support self-care, the interventions used sensors and questionnaires to collect data and used tailoring methods to provide personalized support. The interventions used a total of 34 behavior change techniques, which were facilitated by a combination of 8 features for people with heart failure: automated feedback, monitoring (integrated and manual input), presentation of data, education, reminders, communication with a health care provider, and psychological support. Furthermore, features to support health care providers included data presentation, alarms, alerts, communication tools, remote care plan modification, and health record integration. This scoping review identified that there are few reports of smart health ecosystems that support heart failure self-care, and those that have been reported do not provide comprehensive support across all domains of self-care. This review describes the technical and behavioral components of the identified interventions, providing information that can be used as a starting point for designing and testing future smart health ecosystems.

Therapeutic components of digital counseling for chronic heart failure.

Task force statements support the use of cognitive behavioral therapy (CBT) and motivational interviewing (MI) to promote self-care in chronic heart failure (CHF) patients. Digital counseling interventions have the potential to complement conventional programs. However, therapeutic components of digital programs associated with improved outcomes are not clearly established. Identify therapeutic components of the Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) protocol that were associated with improved health-related quality of life (HRQL). Ordinal logistic regression was used to identify therapeutic components of the CHF-CePPORT protocol. The primary outcome was the 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) tertile. Logistic regressions determined the association between 12-month KCCQ-OS tertile, using logon hours for key segments of the protocol, modality of content delivery, and clinical themes. A total of 117 patients were enrolled in the e-Counseling arm of the CHF-CePPORT trial. Median age was 60 years (IQR 52-69). Total logon hours in the initial 4-month segment of CHF-CePPORT (Sessions 1-16) was associated with increased 12-month KCCQ-OS tertile (Odds Ratio, OR = 1.31, 95% CI, 1.1-1.5, P = 0.001). Within sessions 1-16, improved KCCQ-OS was associated with logon hours for self-assessment tools/trackers (OR = 1.49, 95% CI, 1.1-2.0, P = 0.007), and videos (OR = 1.57, 95% CI, 1.03-2.4, P = 0.04), but not for CHF information pages. This study highlights the importance of using evidence-based guidelines from CBT and MI as core components of digital counseling, delivered through videos and interactive tools/trackers, to improve HRQL with CHF.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.

Dyad Gender and Relationship Quality Influence Heart Failure Self-Care.

Caregivers promote heart failure self-care, yet little is known about how relationship quality and dyad gender influences self-care. The purpose of this study was to evauluate the contribution of dyad gender and relationship quality on heart failure self-care. The study was a secondary analysis from a heart failure self-care intervention. Dyad gender was categorized by patient-caregiver gender as Male-Male (M + M), Female-Female (F + F), Female-Male (Fp + Mc), and Male-Female (Mp + Fc). The Self-Care of Heart Failure Index v.6.2 measured self-care. The Mutuality Scale assessed relationship quality. Univariate linear regression identified determinants of patient self-care maintenance and self-efficacy. The sample (n = 503) was 48% Mp + Fc, 27% F + F, 15% Fp + Mc, and 10% M + M. Better caregiver mutuality in M + M dyads was associated with lower self-care maintenance (b = -7.45, 95% CI [-13.80, -1.11]) and self-efficacy (b = -18.07, 95% CI [-29.11, -7.04]). Better patient mutuality was associated with higher self-efficacy for M + M dyads (b = 12.63, 95% CI [2.18, 23.09]). Mutuality and dyad gender appear important for self-care. Consider the role of gender in the dyad in behavioral interventions.

Measures of Engagement With mHealth Interventions in Patients With Heart Failure: Scoping Review

BackgroundDespite the potential of mobile health (mHealth) interventions to facilitate the early detection of signs of heart failure (HF) decompensation and provide personalized management of symptoms, the outcomes of such interventions in patients with HF have been inconsistent. As engagement with mHealth is required for interventions to be effective, poor patient engagement with mHealth interventions may be associated with mixed evidence. It is crucial to understand how engagement with mHealth interventions is measured in patients with HF, and the effects of engagement on HF outcomes.ObjectiveIn this review, we aimed to describe measures of patient engagement with mHealth interventions and the effects of engagement on HF outcomes.MethodsWe conducted a systematic literature search in 7 databases for relevant studies published in the English language from 2009 to September 2021 and reported the descriptive characteristics of the studies. We used content analysis to identify themes that described patient engagement with mHealth interventions in the qualitative studies included in the review.ResultsWe synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (3239/4771, 67.88%, male), ranging from a sample of 7 to 1571 (median 53.3) patients, followed for a median duration of 90 (IQR 45-180) days. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data in 72% (23/32) of the studies, only qualitatively based on data from semistructured interviews and focus groups in 6% (2/32) of studies, and by a combination of both quantitative and qualitative data in 22% (7/32) of studies. System usage data were evaluated using 6 metrics of engagement: number of physiological parameters transmitted (19/30, 63% studies), number of HF questionnaires completed (2/30, 7% studies), number of log-ins (4/30, 13% studies), number of SMS text message responses (1/30, 3% studies), time spent (5/30, 17% studies), and the number of features accessed and screen viewed (4/30, 13% studies). There was a lack of consistency in how the system usage metrics were reported across studies. In total, 80% of the studies reported only descriptive characteristics of system usage data. The emotional, cognitive, and behavioral domains of patient engagement were identified through qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalization were inconclusive.ConclusionsThe measures of patient engagement with mHealth interventions in patients with HF are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. There is a need for a working group on mHealth that may consolidate the previous operational definitions of patient engagement into an optimal and standardized measure.

A Sensor-Controlled Digital Game for Heart Failure Self-Care Based on Behavioral Change Frameworks.

Self-care behaviors are critical to manage the adverse impact of heart failure disease. However, engaging in self-care behaviors such as physical activity or daily weight-monitoring can be difficult due to lack of knowledge or motivation. Digital games can serve as an alternative to traditional patient education to provide information and motivate engagement in critical self-care behaviors. In this paper, we describe a sensor-controlled digital game (SCDG) in which game play is driven by the player's real life self-care behaviors. We also present the design and development of the next iteration of the SCDG based on playtesting results and behavioral theoretical frameworks.

Assessment of self-care in heart failure patients at a cardiac hospice in Peshawar, Pakistan.

Background: The significance of self-care in heart failure is yet to be demonstrated empirically; however, it's commonly believed that effective self-care delays the development of heart failure. This study aimed to assess the level of self-care among patients with heart failure attending a cardiac hospice center in Peshawar, Pakistan.
 Methodology: A cross-sectional study design was used to examine self-care maintenance, self-care management, and self-care confidence in heart failure patients at Heart Hospice Center, Hayat Abad Medical Complex. A total of 195 heart failure patients were recruited using a convenient sampling method. Data were collected using the Self Care Heart Failure Index (SCHFI) version 6.2.
 Results: The mean SCHFI score (comprising 22 items) across n=195 participants was 50 ± 28.9. A very low percentage (31.28%, n=61) scored an accepted level (≥70) of self-care. On the subscales of self-management, self-confidence, and self-maintenance, the mean scores were 50.0 ± 28.8, 46±26.6, and 50.0 ± 28.7, respectively. One hundred eighty symptomatic patients completed the self-care management subscale who was experiencing shortness of breath and ankle swelling.
 Conclusion: Heart failure patients attending the Heart Hospice Center in Peshawar, Pakistan, did not portray a satisfactory level of self-care behavior. More effective nursing interventions are needed to manage heart failure patients in this center.

Sequential Interventions for Major Depression and Heart Failure Self-Care: A Randomized Clinical Trial.

Major depression and inadequate self-care are common in patients with heart failure (HF). Little is known about how to intervene when both problems are present. This study examined the efficacy of a sequential approach to treating these problems. Stepped Care for Depression in HF was a single-site, single-blind, randomized controlled trial of cognitive behavior therapy (CBT) versus usual care (UC) for major depression in patients with HF. The intensive phase of the CBT intervention lasted between 8 and 16 weeks, depending upon the rate of improvement in depression. All participants received a tailored HF self-care intervention that began 8 weeks after randomization. The intensive phase of the self-care intervention ended at 16 weeks post-randomization. The coprimary outcome measures were the Beck Depression Inventory (version 2) and the Maintenance scale of the Self-Care of HF Index (v6.2) at week 16. One hundred thirty-nine patients with HF and major depression were enrolled; 70 were randomized to UC and 69 to CBT. At week 16, the patients in the CBT arm scored 4.0 points ([95% CI, -7.3 to -0.8]; P=0.02) lower on the Beck Depression Inventory, version 2 than those in the usual care arm. Mean scores on the Self-Care of HF Index Maintenance scale were not significantly different between the groups ([95% CI, -6.5 to 1.5]; P=0.22). CBT is more effective than usual care for major depression in patients with HF. However, initiating CBT before starting a tailored HF self-care intervention does not increase the benefit of the self-care intervention. URL: https://www. gov; Unique identifier: NCT02997865.

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

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

Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care.

Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care. Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors. Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001). Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.

The Situation-Specific Theory of Heart Failure Self-Care Updated: Analysis and Evaluation for Use in Coronary Disease

The Situation-Specific Theory of Self-Care in Heart Failure Updated proposes and explains how situational (person, problem, and environment) and process factors influence self-care actions. The updating of the Theory provides us with a framework to propose process factors as mediators in the influence of self-care. At present, an analysis and evaluation of the Theory for its use in coronary diseases has not been carried out. Objective: to analyze and evaluate the Theory of the Specific Situation of Self-Care in Heart Failure Updated, for its use in research on other coronary disease. Method: The theoretical analysis was carried out according to the analysis strategy proposed by Walker and Avant, which consist of: identifying the origins of the theory, examining the meaning of the theory, logical consistency, utility, transferability, and parsimony. Original indexed studies using the Updated Theory were analyzed. Conclusion: The Theory presents concepts that are simple in their definitions and easy to be explored and measured. The theoretical structure allows hypothesizing that process factors can be tested as mediators or moderators between situational factors and self-care actions. The focus of the theory facilitates its use in creating mid-range and situation-specific theories in other chronic diseases. The theory provides a framework to explore new phenomena related to the decision-making process in self-care and the perception of symptoms in patients with coronary heart disease (such as, acute myocardial infarction, coronary syndrome and others), through the use of qualitative, quantitative correlational and mixed research.