Self-care In Heart Failure Patients Research Articles

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.
 
 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.
 
 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
 
 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.

Effect of telemedicine on self-care in heart failure patients: insights from the iCOR randomised controlled trial

Abstract Background/introduction Poor self-care in heart failure (HF) patients is well recognised to lead to a worse prognosis, through an increased risk of readmissions and mortality. In this regard, the integration of eHealth-based telemonitoring and tele-intervention tools into integrated HF-care programmes could help to improve the self-care of these patients. Nevertheless, the current evidence regarding the impact of eHealth solutions on the self-care of HF patients is scarce. Purpose To evaluate the effect of telemedicine (TM) on self-care behaviour in patients with HF after hospital admission compared to usual care (UC). Methods We designed a post-hoc analysis of the "Insuficiència Cardíaca Optimització Remota" (iCOR) study focussing on self-care. iCOR was a randomised, controlled, single-centre proof-of-concept clinical trial, designed to evaluate the efficacy to adding a eHealth-solution to an existing specialised, comprehensive, multidisciplinary, nurse-based, hospital/primary care integrated HF management programme. Participants were randomised to TM or UC after hospital discharge ("vulnerable-phase") and were followed for 6 months. The primary study endpoint of the current analysis was the delta change of self-care after 6 months of follow-up, assessed using European Heart Failure Self-care Behaviour Scale-12 item (EHFScBS-12 item, lower scores meaning better self-care). To assess the change in self-care between the 2 groups, a repeated-measures ANOVA analysis was performed, adjusted for baseline self-care. Results 178 patients were analysed (81 TM vs 97 UC). The median age of the patients was 74±11 years, 41% were female and the median ejection fraction was 47±17%. Self-care at baseline had a median score of 21.6±10.5 points. As shown in Figure 1, there were no differences in baseline values of self-care between the two comparison groups (21.9±11 TM vs 21.5±11 UC, p-value > 0.05). Both groups experienced an improvement in self-care over time (p-value 0.002 for time effect). However, patients in the TM group experienced greater improvement (from 21.9±11 to 14±0.7 mean Delta change = -7.9±11) than in the UC (21.3±10.5 to 19±0.7, mean delta change = -2.2±10.4, p-value <0.001 in inter-groups comparison) (Figure 1). We designed several multivariate linear regression models exploring the determinants of self-care at baseline and the determinants of change in self-care over time. As shown in Table 1, baseline self-care and randomisation arm were the only independent predictors of improvement of self-care over time. Conclusions Integration of TM into HF care programs can contribute to further improve self-care and thus empowerment in the HF-management.Self-care status changeDeterminants of self-care

The Effect of Self-Care Education on Heart Failure Patients : Literature Review

Heart failure is a heart disease which has an escalating prevalence. Disease conditions that can cause a deterioration in quality of life and even death require further treatment through self-care. Knowledge about self-care can be provided by nurses while the patient is in the hospital even when going home. The purpose of this systematic review is to determine the application of self-care education in heart failure patients to improve self-care knowledge and compliance. The research method used a systematic review design using data bases from ProQuest, EBSCOhost, Scopus, and Science Direct with several keywords used. The results obtained 7 articles that were reviewed after adjusting the inclusion criteria. The results of the study found that the provision of self-care education was able to improve self-care compliance in heart failure patients. The conclusion of this study is that education that is more applicable, interactive and sustainable can improve knowledge and compliance with self-care in heart failure patients.

The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study

BackgroundPatients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients’ ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours.MethodsThis analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours.ResultsA total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097).ConclusionsBased on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients’ engagement in self-care behaviour in this subpopulation.

Patient’s knowledge, gender, and physical activity level as the predictors of self-care in heart failure patients

Introduction: Self-care management is the fundamental approach for Heart Failure (HF) management and is influenced by patient ability in preventing rehospitalization, mortality, and morbidity. Therefore, this study aims to investigate the predictors of a patient’s ability in HF self-care management.&#x0D; Design and Methods: A cross-sectional study was carried out on 96 patients with HF. The data were collected through interviews using questionnaires on demographic characteristics, physical activity (IPAQ), knowledge (Dutch Heart Failure Knowledge Score), and self-care management (Self Care Heart Failure Index). Subsequently, the data were analyzed using logistic regression analysis, and the best fit model for predicting self-care management in HF patients was generated.&#x0D; Results: The proportion of samples was 56.3% female, with mostly primary school (50%) as their education level. Furthermore, the proportion of patients with adequate HF self-care management was only 21% of the total participant. Based on the results, the patient’s physical activity level, HF knowledge, and gender were verified as a predictor of self-care management.&#x0D; Conclusions: The HF knowledge level, physical activity level, and gender were the predictors of HF self-care management.

CORRELATION BETWEEN FAMILY SUPPORT AND SELF-CARE BEHAVIOR OF HEART FAILURE PATIENTS

The decrease in the functional capacity of the heart to pump blood accompanied by symptoms of dyspnea causes heart failure patients to have physical limitations. This condition causes the patient to be unable to carry out self-care optimally, thus requiring the help of others, especially family. The study aimed was to identify the relationship between family support and behavior self-care of heart failure patients. The research design used a cross-sectional with many samples as many as 104 respondents. The research variable is family support, and self-care behavior measured using a questionnaire was declared valid and reliable. Data analysis used the Spearman rank test. The results study 53,8% of respondents moderate family support, and 47,1% of respondents have fewer self-care behavior skills. The Spearman Rank test results obtained p=0,000, with a correlation coefficient value of 0,709. The study concluded a relationship between family support and the self-care behavior of patients with heart failure, the relationship positively and strong. Better family support provides better self-care behavior will be. Nurses have a role to motivate families to be actively involved during the patient's self-care process while in the hospital or at home. Self-care for patients that can be carried out by the family in the form of caring for the family with the patient's condition, accepting the family with the patient's condition, providing assistance and seeking information about the patient's illness.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Interplay between psychosocial and heart failure related factors may partially explain limitations in self-efficacy in patients with heart failure: Insights from a real-world cohort of 1,123 patients

Background and aimsWorse self-care is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Little is known about how the interplay between clinical and psycho-social factors may modulate self-care behaviours in these patients. The aim of our study was to identify clinical, and particularly psycho-social factors associated with worse self-care and assess their interaction inpatients with heart failure. Methods and resultsWe conducted an observational, prospective, cohort study of 1,123 consecutive patients with chronic heart failure. Self-care was assessed with the modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9), and both clinical and psycho-social profile of the patients included were also meticulously evaluated. A total of 484 patients (43%) were women, mean age was 72 years, and mean left ventricular ejection fraction was 44.5%. In multivariable analyses combining clinical and psycho-social factors, low social support (OR 3.53, 95% CI [2.13-5.86]; p-value <0.001), absence of caregiver support (OR 2.16, 95% CI [1.34 -3.48]; p-value 0.001) and depressive symptoms (OR 2.40, 95% CI [1.53-3.77]; p-value <0.001) were independent determinants of impaired global self-care. Advanced functional class was associated with better self-care (OR 0.43, 95%CI [0.26-0.70]; p-value 0.001). No other clinical factors remained significantly associated with self-care in these joint models. In discrimination analyses, models containing psycho-social determinants outperformed models only containing heart failure -related (clinical) variables (all p-values<0.001). ConclusionImpairment in self-care behaviour is strongly determined by psycho-social factors. Specifically, low social support, the lack of caregiver support and the presence of depressive symptoms are the main drivers of the risk of impairment of self-care in heart failure patients. Evaluation of self-care and self-care interventions should be complemented by a comprehensive psycho-social assessment in patients with heart failure. AbbreviationsDAMOCLES, Definition of the neuro-hormonal Activation, Myocardial function, genOmic expressionand CLinical outcomes in hEart failure patients; NYHA, New York Heart Failure Association; GAM, Generalized Additive Model; BMI, Body Mass Index; GDS, GeriatricDepression Scale.

Characteristics of Patients Who Do Not Respond to Motivational Interviewing for Heart Failure Self-care.

Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients. The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI. This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change <8 points) or MI responder (score change ≥8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]). Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33-5.00], P = .005) and taking fewer medications (0.83 [0.74-0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25-14.95], P = .021) and higher baseline self-care management (1.06 [1.02-1.09], P < .001), explaining 35% of the variance in HF self-care management. Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions.

A qualitative study of nurses’ experiences of self-care counseling in migrant patients with heart failure

ObjectivesThis study aims to enhance researchers’ and nurses’ understanding of how to best support migrant patients with heart failure in self-care management. Previous research on self-care in heart failure patients has highlighted its importance, particularly among migrant populations. Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care. However, nurses’ experiences of providing self-care counseling to migrant populations with heart failure have not been studied. MethodsA qualitative study was conducted. Nurses working with migrant patients with HF (n = 13) from different types of facility in Western Sweden were interviewed between October and December 2020. Data were collected using semi-structured interviews and analyzed using inductive thematic analysis. ResultsThe main theme that emerged from the interviews was the difficulty for nurses “to find balance” in self-care counseling. The nurses during self-care counseling had: “to accept challenges,” “to use creative strategies,” faced “problems related to health literacy,” and “to work according to their (the nurses’) obligations.” It was evident that nurses faced several challenges in counseling migrants in self-care, including language and cultural barriers, time resource constraints, low levels of health literacy, and experienced disharmony between the law and their professional norms. They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes. ConclusionsTo increase self-care adherence, nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’ health literacy. The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society. Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care.

Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

The Relationship Between Body Awareness and Self-care in Patients With Heart Failure: Moderating Effect of Age.

Recognizing changing symptoms is challenging for patients with heart failure (HF), especially older patients. Body awareness involves an attentional focus on and awareness of internal bodily changes. Patients with poor body awareness are unlikely to recognize subtle bodily changes, which may result in improper self-care. Despite the potential benefits of body awareness, its contribution to HF management has not been examined. The aims of this study were to examine the relationship between body awareness and self-care in patients with HF and explore whether this relationship varies by age. Patients (N = 136) completed the Body Awareness Questionnaire and 2 scales of the Self-care of HF Index (maintenance and management). Linear regression models were constructed to explore the relationship between body awareness and self-care after controlling for covariates. The moderation effect of age on the relationship between body awareness and self-care was examined using the PROCESS macro. Body awareness was associated with self-care maintenance (unstandardized coefficient = 0.19; 95% confidence interval, 0.05-0.34) but not management. When the interaction effect of body awareness and age was entered in the regression model, neither self-care maintenance nor management was related to this interaction term. We found that body awareness is conducive to self-care maintenance but not self-care management in patients with HF, and the relationship between body awareness and self-care did not vary by age. Our findings suggest that relying on internal body sensations may be insufficient to facilitate self-care management. Thus, other strategies along with the strategies to enhance body awareness are necessary to improve the full process of self-care in HF patients.

Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial

PurposeAnxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention.MethodsThis was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year.ResultsWe enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2.ConclusionClinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).

GAMBARAN MOTIVASI DAN PARTISIPASI KELUARGA DALAM PERAWATAN MANDIRI PASIEN GAGAL JANTUNG

The inability of the heart to pump blood adequately accompanied by dyspnea causes people with heart failure to have physical limitations. These symptoms result in the patient being unable to perform self-care optimally, so they need help from others, especially family. This study aims to identify the description of motivation and family participation in the self-care of heart failure patients. The research design used was descriptive quantitative research with 152 respondents who were drawn by purposive sampling technique. The results showed 62.5% women, and aged between 40-59 years. Forms of family motivation are family care about the patient's illness, family acceptance of the patient's condition, and family assistance to a health service center. Family participation was divided into three, with the highest score being self-care management who contacted the doctor or nurse, and advised the family to take medication when symptoms appeared. Participate in self-care with an assessment of readiness to work, and follow given medication instructions. Then the maintenance of self-care, namely leaving the family to exercise control with a doctor or nurse, and treatment of patients so they don't drink, forget to drink using a medicine box.

Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology.

Self‐care is essential in the long‐term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self‐care is related to medical and person‐centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self‐care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.

Association between sleep quality and self-care in adults with heart failure: A systematic review.

Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute's Critical Appraisal Tools. Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.

Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial.

AimsSelf‐care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self‐care maintenance (primary endpoint; e.g. taking medications), self‐care management (e.g. responding to symptoms) and self‐care confidence (or self‐efficacy) 3 months after enrolment; (ii) changes self‐care over 1 year, and (iii) augments patient self‐care if informal caregivers are involved.Methods and resultsParallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face‐to‐face MI session with three telephone contacts. Self‐care was evaluated with the Self‐Care of HF Index measuring self‐care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self‐care; ≥70 is considered adequate. At 3 months, self‐care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self‐care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self‐care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow‐ups. Over 1 year, Arm 2 had the best scores in self‐care management.ConclusionsMI significantly improved self‐care in HF patients. Including caregivers may potentiate the effect, especially in self‐care management. http://ClinicalTrial.gov, identifier: NCT02894502.

The Self-Care of Heart Failure Index: A psychometric study.

The Self-Care of Heart Failure Index is an empirically tested instrument to measure self-care of heart failure patients across different populations and cultures. To develop and evaluate the psychometric properties of the Nepali Self-Care of Heart Failure Index. This psychometric study used a cross-sectional, observational, study design to collect data. The study was guided and reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. To develop and culturally validate Nepali Self-Care of Heart Failure Index, a combination of the recommended methods for cross-cultural validation studies were applied such as translation, back translation, expert committee review of the translated version and validity/reliability testing. Face and content validity were ensured using expert review. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis. Composite reliability scores were calculated for each sub-scale of the Nepali Self-Care of Heart Failure Index. A total of 221 heart failure patients in Nepal were enrolled in the study. Adequate face and content validity were ensured through expert review. Exploratory factor analysis and confirmatory factor analysis supported the original three-factor model. Although the three factors explained only 41% of the variance, confirmatory factor analysis fit indexes and error measures were found reasonable. The composite reliability coefficients for self-care maintenance, management and confidence scale were 0.6, 0.7 and 0.8, respectively. The Nepali Self-Care of Heart Failure Index is a theoretically based, culturally acceptable and appropriate instrument for use among Nepali heart failure patients. However, further studies are needed to refine its psychometric properties. Access to reliable, valid and culturally appropriate instruments is crucial in describing the state of the problem as well as for developing and evaluating tailored and targeted self-care practice interventions for Nepali patients living with heart failure.

Role of nurses to improve self-care in heart failure patients: a systematic review and meta-analysis

Abstract Introduction Heart Failure (HF) is a pandemic chronic disease with a prevalence up to 3% in the general population, representing the main cause of hospitalization for people over 65. Self-care plays a central role in the management of patients with HF, showing evidence of effectiveness in reducing re-hospitalization rates and mortality. Methods We carried out a systematic review and meta-analysis to assess the efficacy of nurse-led educational interventions Vs usual care in improving self-care skills of patients with chronic HF. The main biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led educational interventions performed on adults with a previous diagnosis of HF. Improvement of HF self-management skills (self-care level) was summarized by calculating the standardized mean difference (SMD) and 95% confidence intervals (CI) stratified for the length of the follow-up. Results Globally, 14 RCTs were included involving 2078 participants. Ten studies showed the efficacy of the interventions at 3 months (short term) with a SMD of 0.78 (95% CI 0.38-1.18) in favor of the self-care education interventions. Five studies reported on self-care abilities at 6-9 months (medium term), not showing statistically significant results (SMD 0.35, 95%CI 0.11-0.81). The long-term effect of the educational interventions showed no statistically significant improvement in self-care behaviors (three studies, SMD 0.05, 95CI% 0.12 - 0.22). Conclusions These results show that nursing educational interventions improve self-care behaviors in HF, but mainly in the short term. Intensive educational interventions led by nurses, associated with appropriate continuity and transition of care, can determine the best outcomes for patients with HF, strengthening self-care behaviors over time. This approach could have a major impact not only on individual level, but on the general reduction of complications, hospitalization, medical costs and ultimately mortality. Key messages Nurse-led educational programs have a short-term efficacy in enhancing self-care behaviors among heart failure patients. Post-discharge repeated educational interventions, along with timely and shared plans ruling the transition between the hospital and the other providers, are strongly needed.

Distinct Factors Associated With Better Self-care in Heart Failure Patients With and Without Mild Cognitive Impairment.

A decline in cognition may limit patients' ability to effectively engage in self-care in those with heart failure (HF). However, several studies have shown no difference in self-care between HF patients with and without cognitive impairment. This may indicate that there are more salient factors associated with self-care in HF patients with cognitive impairment compared with those without cognitive impairment. The aim of this study was to explore which factors are related to self-care based on the presence and absence of mild cognitive impairment (MCI) among patients with HF. Patients with HF were recruited from outpatient settings. The Montreal Cognitive Assessment was used to screen for MCI. Self-care was measured with the Self-care of HF Index v.6.2. Two separate stepwise linear regressions were performed to identify which factors (HF knowledge, perceived control, functional status, multimorbidity, executive function, and social support) predicted self-care in HF patients with and without MCI. Of the 132 patients in this study, 36 (27.3%) had MCI. Self-care maintenance and management were associated with social support (β = 0.489) and executive function (β = 0.484), respectively, in patients with MCI. Perceived control was associated with both self-care maintenance and management in patients without MCI (βs = 0.404 and 0.262, respectively). We found that social support and executive function were associated with self-care in HF patients with MCI, whereas perceived control was associated with self-care in HF patients with intact cognition. Clinicians should develop tailored interventions to enhance self-care by considering the distinct factors associated with self-care based on the presence or absence of MCI.