Self-Care Of Heart Failure Index Research Articles

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.

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

Background 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. Objectives 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. Methods 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. Results 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). Conclusions 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.

Abstract 16880: Perceived Control Moderates the Relationship Between Fatigue and Self-Care in Patients With Heart Failure

Introduction: Fatigue is associated with poor self-care in patients with heart failure (HF). However, factors of fatigue include not only physical factors but also psychological factors, making it difficult to manage. Perceived control refers to the ability to cope with threats and has a significant impact on self-care and fatigue. Hypothesis: We hypothesized that a higher perceived control would lead to better self-care, even if the level of fatigue was comparable. This study aimed to determine whether the perceived control moderates the relationship between fatigue and self-care in patients with HF. Methods: In this cross-sectional study, outpatients with HF (n = 165, 78.8% male, mean age = 69.5 years) completed an assessment of fatigue using the Brief Fatigue Inventory (BFI) and perceived control using the Control Attitude Scale Revised (CAS-R). Participants were categorized into four groups with High (H) and Low (L), H/H, H/L, L/H, and L/L, using the median of BFI and CAS-R scores. Self-care was measured using the Self-Care of HF Index (SCHFI v 6.2), which consists of three subscales, maintenance (adherence to treatment), management (management of symptoms) and confidence. All SCHFI scores were standardized (0–100). A higher score indicates better self-care. Analysis of variance was used to examine differences in four groups using the SCHFI scores. Results: There was a significant difference in SCHFI-maintenance (p = 0.018), especially between H/L and L/H (61.8± 17.3 vs. 70.8 ± 17.3, p = 0.026). Additionally, H/H tended to be higher than H/L (71.3 ± 11.73 vs. 61.8 ± 17.3, p = 0.069). There was a significant difference in SCHFI-management (p &lt;0.001). H/H was significantly higher than H/L (60.1 ± 18.6 vs. 38.3 ± 22.5, p = 0.000), and L/H was significantly higher than L/L (53.3 ± 23.8 vs. 33.3 ±22.9, p &lt;0.001). Similarly, significant differences were found in SCHFI-confidence (p &lt;0.001). H/H was significantly higher than H/L (47.2 ± 21.6 vs. 28.8 ± 15.1, p &lt; 0.001), and L/H was significantly higher than L/L (50.2 ± 21.6 vs. 22.8 ± 10.7, p &lt;0.001). Conclusions: Perceived control might moderate the relationship between fatigue and self-care. Interventions for HF self-care require improvements in perceived control as well as physical factors, such as symptoms.

Abstract 12756: The Interplay of Self-Care Maintenance, Social Support, Depressive Symptoms and Anxiety in Predicting Quality of Life in Patients With Heart Failure

Introduction: Depressive symptoms, anxiety, and inadequate social support are predictors of quality of life (QOL) in patients with heart failure (HF), but prediction of QOL is multifaceted and mechanisms underlying association are unknown. Essential to better HF outcomes, self-care maintenance (SCM) may moderate associations among these predictors. The interplay among depressive symptoms, anxiety, social support, and SCM and their influence on QOL remains uncertain. Purpose: To determine whether (1) depressive symptoms and anxiety mediate the association of social support with QOL, and (2) SCM moderates the relationship of social support with depressive symptoms, anxiety, and QOL. Methods: We included 167 patients (61 ± 12 years old, 65% male, 47% NYHA III/IV) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, Brief Symptom Inventory for anxiety, Multidimensional Scale of Perceived Social Support for social support, Self-Care of Heart Failure Index for SCM, and Minnesota Living with Heart Failure Questionnaire for QOL. A moderated mediation model was performed using PROCESS macro. Results: We found an indirect association of social support with QOL, mediated by depressive symptoms and anxiety (Figure). The beneficial impact of social support on depressive symptoms and anxiety varied with SCM, suggesting a dose-response moderation effect, which is attenuated at lower SCM scores (Figure). The indices of moderated mediation via depressive symptoms and anxiety were -.007 (95%CI: -.150, -.002) and -.005 (95%CI: -.010, -.002), respectively. There was no direct nor moderated direct effect. Conclusions: There is a pivotal interplay of SCM, depressive symptoms, anxiety, social support, and QOL in HF. Findings suggest that improvement in depressive symptoms and anxiety may improve QOL in HF. Moreover, good SCM may enhance the positive effect of social support on depressive symptoms and anxiety.

Abstract 16949: The Effects of the Technology-Based Family-Centered Empowerment (T-FamE) Heart Failure Transitional Program: Preliminary Analysis of a Randomized Controlled Trial

Introduction: Health digitization and advanced dyadic science offer new opportunities to enhance the transitional care model for heart failure (HF). The T-FamE program a transitional care model integrating digital health and optimized carer support to enhance the post-discharge outcomes of HF patients. Hypothesis: The T-FamE was more effective than usual care to enhance self-care, perceived control, family function, HRQoL and hospital readmission of HF patients. Methods: From Aug 2021 to March 2022, a RCT randomized 170 post-discharge HF patients (mean age = 69.0; SD=11.5; NYHA Grade II/III/IV = 53.9/40.6/.5.5%. LVEF&lt;40% =58.5%) to the T-FamE or usual care. The 12-week nurse-delivered T-FamE comprises an interactive mobile Apps, which allows i) proactive health monitoring with tailored autonomous guideline-based feedback; ii) family-centerd goal-setting on self-care, iii) personalized drug education, iv) mobile access to nurse, v) video-based HF compass for rehabilitation and self-care. The cardiac nurse conducted three monthly visits for family-based empowerment on disease management. Outcome evaluation by Self-care Heart Failure index, Self-care Self-Efficacy Scale, Control Attitude Scale, Family Functioning Device and EuroQoL at baseline and post-test. Results: Two-way analysis of covariance showed significant greater improvement of T-FamE group on self-care maintenance (F=21.46, p&lt;0.001, η 2 p =0.113), management (F=22.52, p=0.01, η 2 p =0.118), symptom perception (F=69.70, p&lt;0.001, η 2 p =0.29) and confidence (F=13.36, p&lt;0.001, η 2 p =0.073) than the control. They have greater improvement in EuroQoL (F=5.78, p=0.017, η 2 p =0.033) and sense of control (F=5.78, p=0.017, η 2 p =0.033), and significantly lower number ore readmission in one year (-0.278 (95%CI=-0.54, -0.008, p=0.043). Conclusions: The T-FamE is effective to improve the self-care, HRQL and readmission outcomes. Digitalized transitional care model with optimized family support play explain the therapeutic benefits. Autonomous response to health monitoring data may enhance self-care decision-making.

Relationships of person-related, problem-related, and environment-related factors to self-care behaviours and the mediating role of self-confidence among patients with heart failure: Cross-sectional analysis of structural equation modelling

BackgroundPromoting self-care behaviours in heart failure management is an important goal and challenge for healthcare systems worldwide. Using the situation-specific theory of heart failure self-care, this study examined the relationships of person-related, problem-related, and environment-related factors to self-care behaviours and the mediating role of self-care confidence in these relationships. MethodWe analysed the baseline data from a previous randomised controlled trial study involving 213 patients with heart failure. Structural equation modelling was used to test our hypothesised model that included age, income, education, depression, anxiety, number of comorbidities, social support, self-care confidence, and self-care behaviours. Depression and anxiety were measured by the Hospital Anxiety and Depression Scale. Social support was measured by the Short Form of the Social Support Questionnaire satisfaction subscale. The Self-Care of Heart Failure Index (version 6.2) was used to assess self-care confidence and self-care behaviours (i.e., self-care maintenance and self-care management). ResultThe final model included age, depression, social support, and self-care confidence as independent variables. Age had a direct relationship with self-care maintenance (β = 0.235, p < 0.001) but not self-care management (β = 0.067, p = 0.179); better social support was directly associated with higher levels of self-care confidence (β = 0.267, p < 0.001); and higher levels of self-care confidence were associated with better self-care maintenance (β = 0.573, p < 0.001) and self-care management (β = 0.683, p < 0.001). The result showed an indirect relationship between social support and self-care maintenance through the mediator of self-care confidence (β = 0.153, p < 0.001), as well as an indirect relationship between social support and self-care management through self-care confidence (β = 0.182, p < 0.001). ConclusionSatisfactory social support can increase self-care confidence, thereby increasing self-care maintenance and management. The findings of this study also implied that self-care maintenance can increase with increasing age. Future interventions directly targeting assessment and management of self-care confidence, available social support, and the age of patients may help enhance their heart failure self-care behaviours.

A Pre-Post, Mixed-Methods Study to Pilot Test a Gamified Heart Failure Self-Care Education Intervention.

Objective: Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours (maintenance, management and confidence), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.

Outcomes of a tailored self-care intervention for patients with heart failure and major depression: A secondary analysis of a randomized controlled trial

BackgroundDepression is a recognized barrier to heart failure self-care, but there has been little research on interventions to improve heart failure self-care in depressed patients. ObjectivesTo investigate the outcomes of an individually tailored self-care intervention for patients with heart failure and major depression, and to determine whether the adequacy of self-care at baseline, the severity of depression or anxiety, or other factors affect the outcomes of this intervention. DesignSecondary analysis of data from a pre-registered randomized controlled trial (NCT02997865). MethodsOutpatients with heart failure and comorbid major depression (n = 139) were randomly assigned to cognitive behavior therapy or usual care for depression. In addition, an experienced cardiac nurse provided the tailored self-care intervention to all patients in both arms of the trial starting eight weeks after randomization. Weekly self-care intervention sessions were held between Weeks 8 and 16; the frequency was tapered to biweekly or monthly between Weeks 17 and 32. The Self-Care of Heart Failure Index (v6.2) was used to assess self-care outcomes, with scores ≥70 on each of its three scales (Maintenance, Management, and Confidence) being consistent with adequate self-care. The Week 16 Maintenance scale score was the primary outcome for this analysis. ResultsAt baseline, 107 (77%) of the patients scored in the inadequate self-care range on the Maintenance scale. Between Weeks 8 and 16, Maintenance scores improved more in patients with initially inadequate than initially adequate self-care (11.9 vs. 3.2 points, p = .003). Sixty-six (48%) of the patients with initially inadequate Maintenance scores achieved scores in the adequate range by Week 32 (p < .0001). Covariate-adjusted predictors of better Maintenance outcomes included adequate Maintenance at baseline (p < .0001), higher anxiety at baseline (p < .05), and higher dosages of the self-care intervention (p < .0001). Neither treatment with cognitive behavior therapy nor less severe major depression predicted better self-care outcomes. ConclusionsDepressed patients with inadequate heart failure self-care are able to achieve clinically significant improvements in self-care with the help of an individually tailored self-care intervention. Further refinement and testing are needed to increase the intervention's potential for clinical implementation.

Clinical effects of cognitive behavioral therapy in heart failure patients: a meta-analysis of randomized controlled trials

BackgroundAbout 20–40% of people with Heart failure (HF) suffer from some depression, which is 4–5% greater than the overall population. This depression can lead to undesirable outcomes, including elevated mortality rate and frequent hospitalization.PurposeThe current study aims to evaluate the impact of cognitive behavioural therapy (CBT) on self-care and the symptoms of depression and anxiety in HF patients.MethodsWe searched PubMed, Web of Science (WOS), Scopus, and Cochrane Library till 15 October 2022. All relevant randomized controlled trials (RCTs) were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). Continuous data were pooled as mean difference and 95% confidence interval (CI).ResultsOur search retrieved 1146 records, and 7 studies (611 patients) were finally included. We assessed the Beck Depression Inventory-II (BDI-II) as the primary outcome of the study. Hamilton Rating Scale for Depression (HRSD-17), Change in Beck Anxiety Inventory, Kansas City Cardiomyopathy Questionnaire (KCCQ), and Self-Care of Heart Failure Index (SCHFI) were also assessed as secondary outcomes. With CBT, BDI-II showed a significant reduction after 4 to 6 months follow-up (MD = -4.87, 95% CI: [-8.06; -1.69], P = 0.003) as well as 8 to 9 months follow-up (MD = -5.71, 95% CI: [-8.95; -2.46], P = 0.0006). But no significant difference was shown with 3 months follow-up (M.D=-4.34; 95%CI: [-10.70; 2.03], P = 0.18).ConclusionsCBT has long-term (4–9 months) significant favorable outcomes decreasing anxiety and depression compared to non-CBT groups. No significant short-term (less than 3 months) impact on HF patients’ self-care, depression, or anxiety were shown.

A randomized controlled trial evaluating a theory driven, complex intervention centered on task sharing and mobile health to improve selfcare and outcomes in heart failure – The PANACEA-HF RCT: Design and rationale

BackgroundWe developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the ‘extant cycle’ theory – a theory based on our formative work. MethodsThis is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to ‘transition’ the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a ‘physician supervisor’. ResultsWe recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being ‘lack of knowledge’ 105 (34.5 %) and ‘behavioural passivity’ 23 (7.5 %). ConclusionThis is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.

How patients affected by heart failure and other chronic conditions perform general and specific self-care behaviors

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Centre of Excellence for Nursing Scholarship (CECRI), Rome, Italy. Background Older adults affected by chronic conditions (i.e., heart failure or any other chronic condition) need to perform self-care. It includes behaviors to maintain a healthy lifestyle (self-care maintenance), monitor signs and symptoms of chronic diseases (self-care monitoring), and manage them (self-care management). Performing self-care, allows patients to improve their quality of life, reduce hospital admission rates, and mortality. In patients affected by Heart Failure (HF) and other chronic conditions, also specific self-care behaviors are needed. To date, no prior studies have investigated general and specific self-care behaviors in patients with HF and other chronic conditions. Purpose Investigate how patients affected by HF and other chronic conditions perform general and specific self-care. Methods Cross-sectional study. We collected data from April 2017 to October 2021 in Italy. Patients with HF and other chronic conditions with more than 65 y/o were enrolled in community and outpatient settings. The Self-Care of Chronic Illness Inventory (SC-CII) and The Self-Care of Heart Failure Index (SCHFI) were used to measure generic and specific self-care behaviors, respectively. Values ≥70 indicate adequate self-care behaviors. Paired t-test was performed to identify differences between SC-CII and SCHFI scores. Results A sample of 369 patients with HF was enrolled. 53.3% was female with a mean age of 78.91(±7.41) years, and a median of 3 chronic conditions. The two chronic conditions most frequently associated with HF were Hypertension (75%) and Diabetes Mellitus (70%). Results showed inadequate general self-care maintenance (66.11±14.7) and management (57.77±20.1). Instead, general self-care monitoring was adequate (76.26±20.4). Specific HF self-care maintenance, monitoring and management were inadequate and equal to 57.54 (±17.24), 53.41 (±25.32) and 54.48 (±20.02), respectively. Specific self-care in HF is significantly lower than general self-care behaviors (p&amp;lt;0.001). Conclusion Patients showed more difficulties performing general self-care maintenance and management respect self-care monitoring. Regarding specific HF self-care, patients perform inadequate self-care behaviors in all dimensions. Knowing the lower self-care behaviors is important for clinicians to develop tailored interventions. In particular, patients with HF and other chronic conditions need to be supported in specific self-care behaviors.

Caregiver contributions to general and specific self-care of patients affected by heart failure and other chronic conditions

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Centre of Excellence for Nursing Scholarship (CECRI), Rome, Italy. Background Older adults with HF and other chronic conditions often need the support of informal caregivers in performing self-care. Caregiver contribution (CC) to patient’s self-care includes a series of recommendations (or acts to replace) made to the patient to keep their own health conditions stable and manage signs and symptoms of their chronic conditions. CC to general and specific patient self-care represents help that improves patient clinical outcomes and maintains the stability of chronic conditions. To date, no studies have investigated general and specific caregiver contributions to the self-care of patients with Heart Failure (HF) and other chronic conditions. Purpose Investigate caregiver contribution to general and specific self-care in patients affected by HF and other chronic conditions. Methods Cross-sectional study. Data collection was conducted in community and outpatient settings, from April 2017 to October 2021. Caregivers of patients affected by HF and other chronic condition were enrolled if they were &amp;gt;18 years old and identified by the patient as the primary informal caregiver. Caregiver Contribution to Self-Care of Chronic Illness Inventory (CC-SC-CII) and Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI), were used for measuring generic and specific CC to self-care, respectively. Values ≥70 indicate adequate CC to general and specific self-care behaviors. Paired t-test was carried out to test differences in CC-SC-CII and CC-SCHFI scores. Results This study enrolled 369 caregivers caring for HF patients and other chronic conditions. The sample was composed mainly of females (61.27%) with a mean age of 45.0 (±1.41) years, and that lived with their loved ones (55.28%). The two chronic conditions most frequently associated in patients with HF cared for by informal caregivers were hypertension (75%) and diabetes mellitus (70%). General CC to self-care maintenance, monitoring, and management were adequate with mean scores of 70.57 (±21.6), 81.47 (±21.85), and 72.98 (±20.61), respectively. Specific CC to self-care maintenance, monitoring, and management were inadequate with mean scores of 64.49 (±16.76), 54.08 (±26.71), and 65.24 (±17.25), respectively. CC-SC-CII scores were significantly (p&amp;lt;.0001) higher than CC-SCHFI scores. Conclusion Caregivers showed more difficulties in the contribution to specific HF self-care compared to general self-care behaviors. Knowing how caregivers contribute to self-care is important for clinicians to develop psychosocial interventions for improving CC to self-care in patients with HF and other chronic conditions.

Understanding symptom perception from the psycho-cognitive schemata of patients with heart failure: an exploratory cohort study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Introduction Symptom perception emerges as an important determinant of effective self-management and health outcomes of heart failure patients. Even various care models were developed to improve symptom perception, the latest systematic review [1] still conclude its uncertain effectiveness. Seeking further understanding on what determine symptom perception is needed to inform intervention development. Purpose As an integrative theoretical paradigm [2] suggests that symptom perception is a psychological and cognitive representation of bodily sensation, this exploratory cohort study explored how symptom perception was related to the emotional status, self-care self-efficacy, and disease Knowledge of heart failure patients after adjusting for the priori clinical-demographic profile. Methods From Feb 2017 to Aug 2019, 366 heart failure out-patients, who had been diagnosed for at least six months and at NYHA Class II or above, were recruited from the Department of Cardiology of three regional hospitals in Hong Kong. Symptom perception was measured by the corresponding subscale of the Self-Care Heart Failure Index (SCHFI). The psychological and cognitive correlates were measured by the Self-care Self Efficacy Scale, a single-item depression scale and the Dutch Heart Failure knowledge test. Multiple regression analysis was conducted to identify how symptom perception was associated with factors in the psycho-cognitive schemata of heart failure patients after controlling the demographic characteristics, comorbidity and functional status. Results The mean age of the sample was 67.0 (SD = 10.7). About 40.0% of them had reduced left ventricular ejection fraction and 75% were in NYHA Class II. The symptom perception was poor, with about 79% of patients had the SCHFI Symptom Perception Scale score lower than the criterion level of 70. About 42-68% of the patients did not adequately attend to the classical symptoms and medication side effects of heart failure. More patients (64%) only paid attention to the non-specific feeling of wellness. Multiple regression analysis indicated that, after controlling the priori confounders, lower depression (β= 0.112, 95%Ci = 0.260 – 2.540, p = 0.016), better self-care self-efficacy (β= 0.463, 95%Ci = 0.345 – 0.513, p&amp;lt;0.001) and higher HF knowledge (β= 0.114, 95%Ci = 0.173 – 1.602, p = 0.015), independently associated with better symptom perception. Conclusion This study identifies fair disease-specific symptom perception among patients with heart failure. The results urge for effective care intervention to strengthen this important self-care determinant. In addition to prepare for their cognitive knowledge, strategies to strengthen their self-care self-efficacy and emotional wellness may also play a crucial role for the treatment effectiveness.

Association of heart failure symptoms burden with physical well-being: exploring the roles of self-care and sleep quality using a moderated-mediation analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with heart failure (HF) commonly experience symptom burden. Symptoms such as breathlessness, fatigue, and fluid retention can have an important impact on the patient's daily activities and overall health. Given the evidence of symptoms' negative impact on the quality of life in patients with HF, self-care maintenance is critical. However, there is a paucity of knowledge regards the role played by self-care and the quality of sleep in this population. Purpose To explore the association between HF symptoms burden and quality of life (i.e., physical well-being) and how the association was moderated by levels of self-care maintenance and mediated by sleep quality. Methods This was a secondary analysis of a single-center cross-sectional study conducted in Spain, between February and December 2017. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS), and quality of life was assessed using the physical well-being subscale of the 12-Item Short Form Survey (SF-12). Self-care was assessed using the self-care maintenance subscale of the Self-Care Heart Failure Index (SCHFI) (version 6.2), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A moderated-mediation analysis was conducted to explore the role of self-care as a moderator and sleep quality as a mediator in the association using SPSS PROCESS macro with 5000 bootstrap samples, adjusted for age, sex, Body Mass Index (BMI) and NYHA covariates. Results A total of 178 patients completed the questionnaires. The patients were older (mean age 80, SD ±8,9) with a mean BMI of 29 (SD ± 5,5). About of patients were males (50.6%) and NYHA class 1 or 2 (58.4%). Symptom burden was negatively associated with sleep quality (B = -.104, t(1, 176) = -7.7675, p = &amp;lt;,001), which was positively associated with physical well-being (B = .5664, t(1, 176) = 2.9810, p = .003). The association between symptom burden and physical well-being was moderated by self-care maintenance (interaction value= -.0038, t(1, 176) = -2.0022, p = .047). In the moderated mediation analysis (Figure 1), we found that the direct effect strength of burden symptom on physical well-being was different by the level of self-care maintenance (Johnson-Neyman value= 32.3560, low = 15.1685 high = 84.8315). There was also a significant indirect effect of symptom burden on physical well-being through sleep quality adjusted (B = -.0589, 95% CI [ -.1001, -.0230]). Conclusion Self-care maintenance moderates the association symptom burden and physical well-being, while sleep quality acts as a mediator in the association. Improving quality of life, while empowering self-care, should also consider an evaluation and improving stretegies of sleep quality as it impacts physical quality of life.Moderated-mediation analysis

Psychometric properties of the Japanese version of the Self-Care of Heart Failure Index version 7.2.

It is more important for patients with heart failure (HF) to objectively identify their self-care status. The Self-Care of Heart Failure Index (SCHFI) version 7.2 is a reliable and valid instrument comprising three scales: self-care maintenance, symptom perception, and self-care management. We aimed to translate the SCHFI v.7.2 into Japanese and test its validity and reliability. This was a cross-sectional study. Two translators performed forward and backward translations between English and Japanese. To assess structural validity, confirmatory factor analyses were performed using the structure of the original version. To assess convergent validity, the associations between each scale and self-care self-efficacy were evaluated. To assess internal consistency, model-based internal consistency coefficients were calculated. Participants were 314 Japanese outpatients with HF (mean age: 72.8 ± 12.8 years). Regarding structural validity, all scales showed adequate model fit indices, supporting a two-factor structure with items similar to those in the original version. However, to improve the model fit indices, it was necessary to add error correlations for the self-care maintenance and symptom perception scales. Regarding convergent validity, all scales showed significant associations with self-care self-efficacy. Regarding internal consistency, the model-based internal consistency coefficients were sufficient for all scales (0.739, 0.908, and 0.783 for the self-care maintenance, symptom perception, and self-care management scales, respectively). The Japanese version of the SCHFI v.7.2 had adequate validity and reliability. This instrument is useful for assessing self-care in Japanese HF patients. However, factors influencing self-care should be considered when interpreting results.

Heart Failure Management Capability and Exacerbation of Heart Failure - A 6-Month Prospective Cohort Study.

Background: In households with older individuals, where a patient is experiencing heart failure (HF), effective cooperation between patients and caregivers is crucial for disease management. However, there is limited evidence regarding the impact of cooperative HF management on the incidence of exacerbation. Therefore, the aim of this 6-month prospective cohort study was to investigate the association between HF management capability and exacerbations. Methods and Results: The study enrolled outpatients (age ≥65 years) with chronic HF from a cardiology clinic and their caregivers. Self-care capabilities among patients and caregivers were evaluated using the Self-Care of Heart Failure Index (SCHFI) and Caregiver Contribution-SCHFI, respectively. Total scores were calculated using the highest score for each item. During the follow-up period, 31 patients experienced worsening HF. The analysis revealed no significant association between the total HF management score and HF exacerbation among all eligible patients. However, in patients with preserved left ventricular ejection fraction (LVEF), high HF management capability of the family unit was associated with a reduced risk of HF exacerbation, even after adjusting for the severity of HF. Conclusions: In older patients with HF and preserved LVEF, effective HF management may contribute to a lower risk of exacerbations.