Self-Care Of Heart Failure Index Research Articles

Efficacy of Information-Motivation-Behavioral Skills ModelBased nursing care intervention in management of patients with Heart Failure: A retrospective cohort study.

Self-care practices are integral part of heart failure (HF) management. Information-Motivation-Behavioral skills (IMB) model has shown promise in fostering better self-care behaviors, but its efficacy in management of HF patients remains underexplored. This retrospective study investigated the value of IMB model-based nursing intervention for improving self-care, hemodynamic indicators, and quality of life (QOL) of HF patients. This retrospective study involved 308 HF patients treated at a tertiary care hospital from January 2021 to January 2023. Patients were grouped based on the received nursing care. The intervention group contained patients who received IMB model-based nursing intervention (n=151), and a control group included patients who got routine nursing care (n=157). IMB intervention comprised information delivery, motivation enhancement, and behavioral skills training. Key outcomes included self-care behavior measured by the Self-Care of HF Index (SCHFI), quality of life, assessed by the Minnesota Living with HF Questionnaire (MLHFQ), and hemodynamic parameters including Left Ventricular End-Systolic Diameter (LVESD), Left Ventricular End-Diastolic Diameter (LVEDD), and Left Ventricular Ejection Fraction (LVEF). IMB model-based nursing intervention was significantly more effective in improving the condition of HF patients than the routine nursing care, including better SCHFI and MLHFQ scores and improved hemodynamic parameters (LVESD, LVEDD, and LVEF) (P<0.05). Variation in different analysis further confirmed the efficacy of the IMB model-based nursing intervention. IMB model-based nursing intervention significantly improved self-care behavior, QOL, and hemodynamic parameters in HF patients. This mode of nursing care has a potential as a valuable strategy for enhancing HF management.

The Effects of Teach-Back and Blended Training on Self-Care and Care Burden Among Caregivers of Patients with Heart Failure Caregivers.

A quasi-experimental study aimed to investigate the effects of both teach-back and blended training methods on the contribution to self-care and perceived care burden among family caregivers of patients with heart failure. Seventy family caregivers of patients with heart failure were randomly allocated to two groups: one receiving the teach-back method and the other receiving the blended training method. Data were collected before, 1 month, and 3 months after the intervention. Data collection included demographic data and two tools: the Caregiver Contribution to Self-Care of Heart Failure Index and the Caregiver Burden Questionnaire for Heart Failure. Both teach-back and blended training methods were effective in educating family caregivers of patients with heart failure requiring home care. However, the teach-back method demonstrated better outcomes for the two concepts examined in this study.

Self-Care of Older Patients Affected by at Least Two Chronic Conditions Between Heart Failure, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: A Comparative Study.

This study aims to describe disease-specific self-care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self-care behaviours within patient groups; and to evaluate differences across these groups. Cross-sectional study. A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self-Care of Heart Failure Index, Self-Care of Diabetes Inventory and Self-Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease-specific self-care behaviours. Group comparisons were performed using Student's t-test and univariate, followed by multivariate analyses of variance. The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self-care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self-care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self-care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD). The findings provide valuable insights into the complexities of self-care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient-centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population. All the authors have adhered to the EQUATOR guidelines STROBE Statement. A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face-to-face during routine outpatient visits or directly at the patient's home.

The Effect of Heart Failure Symptom Clusters on Quality of Life: The Moderating Effect of Self-Care Behaviours.

Although heart failure (HF) symptoms affect patients' quality of life (QoL), improving patients' QoL requires certain self-care behaviours. However, the specific role of self-care behaviours in the relationship between HF symptoms and QoL has not been clarified. To evaluate the status of symptom clusters, self-care behaviours and QoL in HF patients, and to analyse and test the moderating effect of self-care behaviours between symptom clusters and QoL. This study is a cross-sectional study. A total of 320 HF patients who treated in thethree hospitals in Chengdu, China, from December 2022 to July 2023 were selected as the research subjects. The patients were evaluated using The General Information Questionnaire, Memorial Symptom Assessment Scale Heart Failure, Self-Care of Heart Failure Index and Minnesota Living with Heart Failure Questionnaire. The statistical analysis methods were exploratory factor analysis, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. There were five symptom clusters in HF patients: emotional symptom cluster (sadness, anxiety, irritability, feeling nervous), digestive symptom cluster (lack of appetite, dry mouth, weight loss, nausea, abdominal distension), ischemic symptom cluster (dizziness, chest pain, palpitations, fatigue), dyspnoea symptom cluster (difficulty breathing when lying flat, waking up breathless at night, sleep difficulty) and congestion symptom cluster (cough, shortness of breath, oedema). There was a significant correlation between HF symptom group, self-care behaviours and QoL (p < 0.05). Both self-care maintenance (β = -0.262, p < 0.001) and self-care management (β = -0.258, p < 0.001) had a moderating effect between symptom clusters and QoL. There are a variety of symptom clusters in HF patients. Improving the self-care behaviours ability of HF patients is conducive to reducing the impact of HF symptom clusters on QoL. The study used the STROBE checklist for reporting. Medical staff should focus on the impact of HF symptom clusters and self-care behaviours on QoL, and formulate corresponding interventions for HF symptom clusters and self-care behaviours to improve the QoL of patients. The head nurse of the cardiovascular department actively assisted us in collecting questionnaires from HF patients, and all HF patients surveyed participated in this study seriously.

Resilience and Self-Care in Patients with Heart Failure: A Cross-Sectional Study

Background: A key component of managing heart failure, self-care can significantly affect patient outcomes. Patients may find the constant and intricate demands of self-care stressful, and they may need to show resilience to manage their symptoms. Objectives: The present study aimed to identify resilience and self-care among patients with heart failure. Methodology: The design of the present study was cross-sectional. The research population consisted of heart failure patients visiting the cardiac hospitals and admitted to the cardiac ward. A convenience sampling method was used to select 200 patients with heart failure. The data were collected from April 6th, 2023 to June 29th, 2023 about the participants’ demographic variables, Self-Care of Heart Failure Index (SCHFI V6.2 English), and the Connor-Davidson Resilience Scale (CD-RISC). The data were analyzed using descriptive statistics (percentage, frequency, standard deviation, mean score) for the demographic variables. To assess reliability, Cronbach’s alpha was used. Results: The present study showed that the majority of sample (n=185, 92.5%) had a medium level of self-care in symptom perception (Mean±SD= 28.86±16.32), self-care maintenance (Mean±SD= 34.2±15.63), and self-care management (Mean±SD= 35.52±17.25). The research findings showed a strong negative association between patients' resilience and self-care (p&lt;0.001). There was a statistically significant association between self-care and participants’ marital status (p=0.02). Self-care was greater among those who were married. Conclusion: The present findings showed that patients with heart failure had a moderate level of self-care and resilience. There were associations between resilience and self-care in heart failure patients. The variables that may mediate or affect self-care need to be well-recognized by the research population

Measuring Self-Care: A Description of the Family of Disease-Specific and Generic Instruments Based on the Theory of Self-Care of Chronic Illness.

In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com. These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness. The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described. Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

Exploring the Influence of Contextual Factors and the Caregiving Process on Caregiver Burden and Quality of Life Outcomes of Heart Failure (HF) Dyads after a Hospital Discharge: A Mixed-Methods Study.

Background: This study explores heart failure (HF) dyadic contextual factors and caregiver burden during acute exacerbation hospitalization and discharge. Methods: It employed a mixed-methods approach, with HF dyads completing questionnaires and semi-structured interviews at a one-week post-discharge outpatient visit. Quantitative tools included the SF-12 Quality of Life, Zarit Burden Interview (ZBI), Bakas Caregiving Outcomes Scale (BCOS), and Self-Care of Heart Failure Index v. 6 (SCHFI). Thematic analysis was conducted on interview data to assess caregiver burden, disease trajectory, comorbidities, caregiving time, and employment status. Results: Twelve HF dyads participated, with caregivers (six female, six male) averaging 65.76 years. The ZBI indicated a low caregiver burden (median score of 15), but qualitative data revealed a higher perceived burden related to social isolation, future fears, and caregiver dependence. Male caregivers reported a lower burden than females. Positive goal congruence was noted in caregiving hours and HF management compliance. HF patients had a 10-year survival prediction of 22.75% per the Charlson Comorbidity Index, with 69% in NYHA class III and an average ejection fraction of 37.7%. Caregivers working full-time and caring for higher NYHA-class patients showed higher ZBI and BCOS scores. Conclusions: The study highlights the need for mixed methods and longitudinal research to understand HF disease trajectory and caregiver burden, emphasizing the importance of including caregivers in HF education and screening for perceived burden to improve outcomes and reduce re-hospitalizations.

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.

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.

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.

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.

Enhancing self-care in elderly patients: the impact of WhatsApp reminder messages at the Heart and Vascular Center

The importance of reminder messages lies in improving self-care among heart disease patients. At the Heart and Vascular Center, many patients, both those under ongoing care and those recently treated, do not consistently engage in self-care activities. Reminder messages can encourage adherence to medication regimens. This study aimed to investigate the effectiveness of WhatsApp reminder messages on the self-care of elderly patients at the Heart and Vascular Center. The research employed a quasi-experimental design with a two-group pre- and post-test control design. Using a probability sampling technique with simple random sampling, the study required 16 new patients in each group. The instrument used was the Self-Care Heart Failure Index (SCHFI) questionnaire, consisting of 22 questions. Data analysis was performed using the Mann-Whitney test. The results indicated that WhatsApp reminder messages are effective in enhancing patient self-care at the Heart and Vascular Center at Premier Hospital Surabaya (p-value&lt;0.001). The Mann-Whitney test results post-intervention showed a p-value of 0.013, confirming the effectiveness of WhatsApp reminder messages in improving self-care among patients. This study demonstrated a significant positive influence of WhatsApp reminder messages on the self-care of elderly patients at the Heart and Vascular Center. These messages are an effective tool for improving patient self-care practices at Premier Hospital Surabaya.

Generic and disease-specific caregiver contribution to self-care in a population with multiple chronic conditions: A comparative study.

Describe and compare generic and disease-specific caregiver contribution (CC) to self-care behaviours in the dimensions of self-care maintenance, self-care monitoring and self-care management in multiple chronic conditions (MCCs). Multicentre cross-sectional study. We enrolled caregivers of patients with MCC, from April 2017 to November 2022, if they were (a) 18 years of age or older and (b) identified by the patient as the principal unpaid informal caregiver. The Caregiver Contribution to Self-Care of Chronic Illness Inventory, Caregiver Contribution to Self-Care of Heart Failure Index, Caregiver Contribution to Self-Care of COPD Inventory and Caregiver Contribution to Self-care of Diabetes Inventory were used to measure generic and disease-specific contribution to patient self-care. Descriptive statistics, Student's t-tests and Pearson's correlation coefficients were used. We found adequate generic CC for self-care monitoring but inadequate CC in self-care maintenance and management. All CC to disease-specific self-care maintenance, monitoring and management scales' scores were inadequate, except for caregivers of diabetic patients in which we observed an adequate score in the CC to self-care maintenance and self-care management scales in those practice insulin therapy. Caregivers experience difficulties in performing behaviours of contribution to their patients affected by chronic conditions. Caregivers of patients with MCCs contribute more to self-care in aspects related to provider prescriptions and less to lifestyle changes. Healthcare professionals have to know in which behaviours caregivers show gaps and reflect on the reasons for poor CC to self-care to develop interventions to enhance these behaviours. This study underlines the importance of choosing the most appropriate instrument for measuring CC to self-care, considering the caregiver's characteristics. We adhered to STROBE guidelines. Caregivers of patients affected by MCCs were enrolled.

Depressive symptoms are associated with clinical outcomes in heart failure with reduced ejection fraction.

The objective of this study was to examine associations between elevated depressive symptoms and increased risk of adverse clinical events patients with heart failure and reduced ejection fraction (HFrEF), as well as the potential contribution of health behaviours. One hundred forty-two men and women with HFrEF were enrolled through heart failure (HF) clinics and followed over time. At baseline and 6months, depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) and HFrEF disease activity by B-type natriuretic peptide (BNP). The Self-Care of Heart Failure Index (SCHFI) was used to assess HF self-care behaviours. Proportional hazards regression models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. Over a median follow-up period of 4years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10-point higher baseline BDI-II score was associated with a 35% greater risk of death or cardiovascular hospitalization. Higher baseline BDI-II scores were associated with poorer HF self-care maintenance behaviours (R=-0.30, P<0.001) and fewer daily steps (R=-0.19, P=0.04), suggesting that elevated depressive symptoms may diminish important health behaviours. Increases in plasma BNP over 6months were associated with worse outcomes. Changes in BDI-II and plasma BNP over 6months were positively related (R=0.25, P=0.004). This study confirms that elevated depressive symptoms are associated with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Poor health behaviours may contribute to the adverse association of elevated depressive symptoms with the increased hazard of adverse clinical outcomes.

Psychometric Evaluation of the Traditional Chinese Version of the Self-Care of Heart Failure Index Version 7.2.

The Self-Care of Heart Failure Index (SCHFI) is a widely used instrument used to measure self-care in both research and clinical settings. The lack of a psychometric evaluation of the traditional Chinese version of the SCHFI (SCHFI-C) might limit its utilization in non-Mainland Chinese populations such as Hong Kong, Macau, and Taiwan. This study aimed to evaluate the psychometric properties of the SCHFI-C v.7.2. Participants included 365 adults with heart failure. Breslin's method of translation was used to translate the SCHFI v.7.2 into traditional Chinese. Exploratory factor analysis was conducted to examine the dimensionality structure of each scale. Then, composite reliability was calculated to assess the reliability of 3 scales. Construct validity was examined by hypothesis testing and known-group comparisons. The results of exploratory factor analysis suggest its multidimensionality of each scale. More specifically, the findings indicated a unique internal structure of the self-care maintenance ("lifestyle-related behaviors" and "consulting behaviors") and self-care management ("self-reliance behaviors" and "help-seeking behaviors") scales. The composite reliability of 3 scales were 0.81, 0.88, and 0.82, respectively, reaching adequate level. As for construct validity, the significant associations between the 3 SCHFI domains and self-care confidence as well as significant group difference among patients of different ages and educational backgrounds supported good construct validity. This study provides evidence of the reliability and validity of the SCHFI-C v.7.2. The traditional SCHFI-C v.7.2 can serve as a valid and reliable outcome measure to evaluate the effects of self-care-promoting interventions.

Effects of a transition care program on depression, self-efficacy, and self-care behaviors in heart failure patients

IntroductionHeart failure is a progressive and unpredictable heart disease. How to work with these patients to decrease their psychological distress and promote their self-care behaviors is important. Transition care is the continuity of medical care for heart failure patients returning home from the hospital. Intervention through transition care may improve the continuity of medical care for patients with heart failure but it has not been examined in clinical settings in Taiwan.ObjectivesThe aims of this study were to explore the effects of a newly developed transition care program on depression, self-efficacy, and self-care behavior of heart failure patients.Methods Using an experimental research design and block randomization, participants were divided into the experimental group (received transition care and routine care) and the control group (received routine care only). The Patient Health Questionnaire-9 (PHQ-9), the General Self-Efficacy Scale (GSES), and the Self-Care of Heart Failure Index (SCHFI version 6.2) were used to collect data before discharge and the first month after discharge.Results A total of 20 patients with heart failure were recruited. No significant differences were found between the experimental (n=10) and control groups (n=10) in the degree of depression (Z=-.077, p=.938), self-efficacy (Z=-1.214, p=.225), and three self-care behaviors subscales (self-care maintenance Z= -1.214, p=.225; self-care management Z= -.401, p=.689; self-care confidence Z=-.436, p=.663) at discharge. After the one-month posttest, only self-efficacy (Z=-2.545, p=.011) and three self-care behaviors subscales (self-care maintenance Z=-3.097, p=.002; self-care management Z= -2.595, p=.009; self-care confidence Z=-3.671, p&lt;.001) reached a statistical difference between the two groups.ConclusionsBased on the preliminary results, heart failure patients can improve their self-care behavior and self-efficacy but not depression through transitional care intervention.Disclosure of InterestNone Declared

Disparities in 30-Day Readmission Between Medicare/Medicaid and Private Insurance Among Patients With Heart Failure Screened for Cognitive Impairment.

Racial disparities exist among patients with heart failure (HF). HF is often comorbid with cognitive impairment. Appropriate self-care can prevent HF hospital readmissions but requires access to resources through insurance. Racial differences exist between insurance types, and this may influence the disparity between races and patients with HF and cognitive impairment. The objectives of this study were to examine the relationships between insurance type and self-care stratified by race and to assess for differences in time-to-30-day readmission among patients with HF with cognitive impairment. This is a secondary analysis of data collected among hospitalized patients with HF with cognitive impairment. Patients completed surveys on self-care (Self-Care of Heart Failure Index), HF knowledge (Dutch Heart Failure Knowledge Scale), depression (Geriatric Depression Scale), and social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory). Socioeconomic data were collected. Linear models were created to examine the relationships between insurance type and self-care by race. Kaplan-Meier curves and Cox regression were used to assess readmission. The sample of 125 patients with HF with cognitive impairment was predominantly Black (68%, n = 85) and male (53%, n = 66). The sample had either Medicare/Medicaid (62%, n = 78) or private insurance (38%, n = 47). Black patients with HF with cognitive impairment and private insurance reported higher self-care confidence compared with Black patients with HF with cognitive impairment and Medicare/Medicaid (P < .05). Medicare/Medicaid was associated with a higher frequency of 30-day readmission and a faster time-to-readmission. Patients with HF with cognitive impairment and Medicare/Medicaid insurance reported lower self-care confidence and more likely to be readmitted within 30 days.

Mediators of the Association Between Cognitive Function and Self-care Behaviors in Patients Hospitalized With an Exacerbation of Heart Failure.

Patients with heart failure (HF) must engage in self-care, yet their self-care is often poor. Cognitive function commonly is impaired in HF and is associated with poor self-care. Heart failure knowledge and self-care confidence also are needed to preform self-care. Few investigators have examined mediators of the association of cognitive function with self-care. The aim of this study was to determine whether HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance and management among patients with HF. This was a cross-sectional observational study of 164 patients with HF. Cognitive function was assessed using the Montreal Cognitive Assessment. Self-care maintenance and self-care management behaviors and self-care confidence were measured using the Self-care of Heart Failure Index. Heart failure knowledge was measured using the Dutch Heart Failure Knowledge Scale. We conducted 2 parallel mediation analyses using the PROCESS macro in SPSS, one for self-care maintenance and one for self-care management. Cognitive function was indirectly associated with self-care maintenance through HF knowledge (indirect effect, 0.54; 95% confidence interval, 0.10-1.02) and self-care confidence (indirect effect, 0.26; 95% confidence interval, 0.04-0.54). Those with better cognitive function had more HF knowledge and self-care confidence. Better cognitive function was not directly associated with self-care management but indirectly associated with better self-care management through higher self-care confidence (indirect effect, 0.50; 95% confidence interval, 0.04-1.05). Both HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance, and only self-care confidence mediated the association between cognitive function and self-care management. Interventions targeting HF knowledge and self-care confidence may improve self-care even for those with lower cognitive function and need to be developed and tested.

Abstract 13139: Preliminary Efficacy of a Cognitive Restorative Nature Intervention to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure

Background: Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL). Goal: The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) on improving attention, HF self-care, and HRQL. Methods: In this 2-group randomized controlled trial, 73 patients with Stage C HF were enrolled. The Nature-VR intervention group (n=37) viewed 3-dimensional nature pictures delivered by a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks. The attention control group (n=36) viewed 3-dimensional urban pictures (Urban-VR) delivered by a virtual reality headset at the same frequency of Nature-VR. Outcomes were: attention measured by Oral Trail Making A and Digit Span Forward; HF self-care measured by Self-care of Heart Failure Index; and HRQL measured by Minnesota Living with Heart Failure Questionnaire. Outcomes were assessed at baseline, 4, 8, 26, and 52 weeks by telephone interviews due to COVID-19 pandemic. Linear mixed models with intention-to-treat analysis were used to test effects of group, time, and group-by-time interactions. Results: Of 73 patients, 41 were women. Self-reported race was 1 Asian, 12 African American, and 60 White. Mean age was 66 years. NYHA class was I/II=33, III=30, and 10 were missing. Sixty-eight patients (93%) completed the interventions; 56 (79% of 68) had ≥ 80% adherence; 51 (70%) completed the study. In mixed models, no significant group-by-time interactions were found in attention, HF self-care, and HRQL. HF self-care (maintenance, management, symptom perception, and confidence) significantly improved over time (p &lt; .001) in both groups. There was significant improvement on symptom perception (p= .004, better in Nature-VR). HRQL showed significant group (p = .041, worse in Nature-VR) and time effects (p = .047, both groups improved). Conclusions: Although preliminary efficacy of Nature-VR compared with Urban-VR was not supported, HF self-care and HRQL improved over 52 weeks. Future testing is indicated of multimodal interventions that include Nature-VR to improve improving self-care and HRQL.

Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships. Purpose: To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups. Methods: In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro. Results: Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]). Conclusion: Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.