Predictors of self-care in persons with heart failure

Predicting cervical cancer screening participation using self-care behaviors among women in Iran

BACKGROUND

Cervical cancer screening is an effective and accessible method for preventing this cancer. However, low participation rates among women have been reported. Self-care is one of the solutions to improve access to health services. This study was conducted to determine the prediction of cervical cancer screening participation using self-care behaviors among women in Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted on 310 eligible women who were referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran, from November 2020 to April 2021. Participants were enrolled using convenience sampling. The data collection tool included researcher-made questionnaires on personal and fertility characteristics, participation in cervical cancer screening, and self-care behaviors related to cervical cancer and its screening. Descriptive and inferential statistical methods were used for data analysis using the Statistical Package for the Social Sciences (SPSS) version 22 software.

RESULTS

The results showed that the intention to undergo screening was low among individuals who had not undergone screening. Lack of awareness and not having enough time were the most common barriers to screening. The results of logistic regression analysis indicated that self-efficacy was the significant predictor of cervical cancer screening. With an increase in the self-care score, the 12% chance of doing a Pap smear increases significantly (P = 0.002). Furthermore, the results of multiple regression showed that with an increase in the self-care score, the chance of women who refer to screening every year, every 2-3 years, and every 4-5 years is increased to 25% (P = 0.001), 34% (P < 0.001), and 11% (P = 0.032), respectively, compared with non-referral.

DISCUSSION

According to the results, self-care was a predictor of performing a Pap smear, and it was related to its regular performance of Pap smear too. Therefore, designing and implementing necessary interventions to increase self-care behaviors can improve women's participation in cervical cancer screening and its regularity.

Perceived social support, self-management, perceived stress, and post-traumatic growth in older patients following stroke: Chain mediation analysis

Stroke is a potentially traumatic event that can lead to both positive changes associated with post-traumatic growth (PTG) and enduring mental distress. This study aimed to investigate the association between perceived stress and PTG among older postsurvivors, as well as to explore the potential mediating role of perceived social support and self-management in this relationship. A cross-sectional study was conducted to recruit 354 older poststroke survivors from 2 tertiary hospitals in Shenyang, China, between January 2022 and October 2023. Various multidimensional scales were utilized to measure perceived stress, perceived social support, self-management, and PTG. Structural equation modeling was employed by Amos 24.0 to analyze the mediating pathways. The average score of PTG was 50.54 ± 22.69 among older poststroke patients. Pearson analysis revealed significant associations between perceived stress, perceived social support, self-management, and PTG (all P < .01). The mediation model showed that perceived stress could both direct influence PTG (Effect = -0.196, 95% CI = [-0.259, -0.129]), and indirectly impact PTG through perceived social support (Effect = -0.096, 95% CI = [-0.157, -0.044]), through self-management (Effect = -0.033, 95% CI = [-0.064, -0.012]), and sequentially through perceived social support and self-management (Effect = -0.007, 95% CI = [-0.017, -0.002]), accounting for 58.9%, 28.8%, 9.9%, and 2.1% of the total effect, respectively. These findings confirmed the mediating roles of perceived social support and self-management between perceived stress and PTG among older poststroke survivors. This provides valuable insights into developing targeted social intervention programs to improve stroke management among older survivors.

Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial

BACKGROUND

Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs.

METHODS

Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments.

RESULTS

In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes.

CONCLUSIONS

These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.

Determinants associated with activation in patients with oral anticoagulant treatment: A cross-sectional study

AIMS

The terms "patient activation" and "patient empowerment" are used to describe the extent to which individuals are able to manage their own healthcare. Health outcomes and quality of life improve in patients who are more active in health care. The aim of this study was to identify sociodemographic, clinical, sociological and psychological determinants associated with activation in a group of chronically anticoagulated patients.

METHODS

Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulant unit between November 2021 and June 2022. The main dependent variable was the level of patient activation according to the 13-item Patient Activation Measure (PAM-13). Simple and multiple linear regression models were conducted to identify the determinants associated with PAM-13 score.

RESULTS

A total of 137 patients who met all the inclusion criteria were recruited for the study. The mean age was 59.6 years (SD 13.8; range 22-86) and 60.6% were male. Sixty per cent presented a level IV of activation according to the PAM-13 scale. Mean patient activation score was 73.9 (SD 15.4). The factors independently associated with significantly lower activation were: emergency department visits in the past 12 months, intermediate social risk, anxiety symptoms, stress symptoms and low self-efficacy.

CONCLUSIONS

Five determinants were found to be associated with activation. Knowing the factors that modify the level of activation can help to identify subgroups of chronic anticoagulated patients who are less likely to engage in self-management and are therefore candidates for tailored educational interventions.

Predictors of patient self-advocacy among patients with chronic heart failure

The purpose of this study was to examine predictors of self-advocacy among patients with chronic heart failure (HF) as they were unknown. A convenience sample of 80 participants recruited from one Midwestern HF clinic completed surveys related to relationship-based predictors of patient self-advocacy including trust in nurses and social support. Self-advocacy is operationalized using the three dimensions of HF knowledge, assertiveness, and intentional non-adherence. Hierarchical multiple regression was used showing that trust in nurses predicted HF knowledge (ΔR² = 0.070, F = 5.91, p < .05), social support predicted advocacy assertiveness (ΔR² = 0.068, F = 5.67, p < .05), and ethnicity predicted overall self-advocacy (ΔR² = 0.059, F = 4.89, p < .05). These findings suggest that support from family and friends can give the patient the needed encouragement to advocate for what they need. A trusting relationship with nurses impacts patient education so that patients not only understand their illness and its trajectory but also use that understanding to speak up for themselves. African American patients, who are less likely to self-advocate than their White counterparts, could benefit from nurses recognizing the impact of implicit bias so that these patients do not feel silenced in their care.

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. 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. 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. Conclusions: The HF knowledge level, physical activity level, and gender were the predictors of HF self-care management.

Self-Care and Compliance with Medication and Their Relationship to the Quality of Life of Patients with Heart Failure

INTRODUCTION

Heart failure is a major health problem, often accompanied by limited physical activity and severe effects in various areas of patient quality of life. Self-care, as well as compliance with medication, can further contribute to clinical stability and improved patient outcomes.

PURPOSE

The purpose of this chapter is to assess the effect of self-care and compliance with medication, on the quality of life of patients with heart failure.

METHOD

The research sample consisted of 67 patients diagnosed with heart failure who visited the cardiology outpatient clinic of a general hospital in the capital of Greece. The assessment of self-care behavior was performed by the scale EHFScBS and SCHFI v.6, the Morsiky Green Levine Adherence Scale (MAQ) was used for the evaluation of adherence to medical treatment, while for the evaluation of the quality of life the questionnaire MLWHFQ was used.

RESULTS

The multifactorial linear regression analysis showed that age, compliance with medication and scoring in the dimension "Self-care confidence" relates independently to the overall quality-of-life scale rating. In particular, participants over 80 had a significantly higher score, that is, worse quality of life, compared to those under the age of 70 (p < 0.001), while participants with low compliance with treatment had a significantly worse quality of life compared to participants with high compliance (p < 0.001). It has been noticed that the better self-care they had and the higher compliance with their medication, their quality of life was better.

CONCLUSION

Self-care behavior and adherence to medical treatment of patients with heart failure are related to their quality of life. Age, educational level, and "Self-care confidence" are factors that influence self-care behavior, compliance with medication, and quality of life. In-depth patient information on the need for adherence to therapeutic guidelines may help to reduce pharmaceutical costs and maximize the therapeutic effect. For this reason, health professionals treating these patients should take into account all the factors that negatively affect their quality of life and treat them with the appropriate interventions.

Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia

Background

Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients.

Purpose

To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals.

Methods

Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression.

Results

In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations.

Conclusion

This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.

Self-care Practices of Patients With Heart Failure Using Wearable Electronic Devices: A Systematic Review

BACKGROUND

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes.

OBJECTIVE

We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home.

METHODS

Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention.

RESULTS

Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies.

CONCLUSIONS

The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

Theory-Based Self-Management Interventions for Community-Dwelling Stroke Survivors: A Systematic Review and Meta-Analysis

IMPORTANCE

Self-management is a critical component of stroke rehabilitation. A better understanding of the use of theory and behavior change techniques (BCTs) informs the development of more effective stroke self-management interventions.

OBJECTIVE

To examine what theories and BCTs have been applied in stroke self-management interventions; investigate the extent to which these interventions encourage implementation of behavior changes; and appraise their effectiveness to enhance self-efficacy, quality of life, and functional independence.

DATA SOURCES

Ovid MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched from inception to May 26, 2020.

STUDY SELECTION AND DATA COLLECTION

Randomized controlled trials (RCTs) in six databases were reviewed for inclusion and analysis. We included trials that involved community-dwelling adult stroke survivors, assessed the effectiveness of self-management interventions, and explicitly mentioned the use of theory in the development of the intervention. We assessed use of theory and BCTs using the Theory Coding Scheme and BCT taxonomy v1, respectively.

FINDINGS

A total of 3,049 studies were screened, and 13 RCTs were included. The predominant theory and BCT categories were Social Cognitive Theory (7 studies) and goals and planning (12 studies), respectively. Significant and small effect sizes were found for self-efficacy (0.27) and functional independence (0.19).

CONCLUSIONS AND RELEVANCE

Theory-based self-management interventions have the potential to enhance stroke outcomes. Systematic reporting on the use of theory and BCTs is recommended to enhance clarity and facilitate evaluations of future interventions. What This Article Adds: This review supports and guides occupational therapy practitioners to use theory-based self-management intervention as a routine part of stroke rehabilitation to improve stroke survivors' experience in the community.

The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure

BACKGROUND

Sleep disturbance is one of the most common symptoms among patients with heart failure (HF), and it may affect the ability of patients to perform self-care. There is a lack of evidence on the association between sleep quality and its components and self-care in adults with HF.

OBJECTIVE

The aim of this study was to evaluate the association between sleep quality and its components and self-care in adults with HF.

METHODS

This study is a secondary analysis of baseline data from the MOTIVATE-HF study, a randomized controlled trial on patients with HF and their caregivers. Only patients' data were analyzed in this study (n = 498). Sleep quality and self-care were evaluated with the Pittsburgh Sleep Quality Index and the Self-Care of Heart Failure Index v6.2, respectively.

RESULTS

A habitual sleep efficiency of 75% to 84% was associated with lower self-care maintenance compared with a habitual sleep efficiency of 85% or greater ( P = .031), as was taking sleep medications once or twice a week compared with less than once a week ( P = .001). A frequency of daytime dysfunction less than once a week was associated with lower self-care management compared with a frequency of daytime dysfunction of 3 or more times a week ( P = .025). Taking sleep medications less than once a week was associated with lower self-care confidence compared with taking sleep medications 3 or more times a week ( P = .018).

CONCLUSION

Poor sleep quality is frequently reported by patients with HF. Sleep efficiency, sleep medications, and daytime dysfunction may influence self-care more than the other sleep quality components.

Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure

OBJECTIVE

Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF.

METHOD

Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake.

RESULTS

Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants' ratings of the first session's utility were associated with greater improvements in physical activity at follow-up.

CONCLUSIONS

These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.

Self-management on heart failure: A meta-analysis

BACKGROUND AND AIMS

Heart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated.

METHODS

The research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis.

RESULTS

Eight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I² = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I² = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I² = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results.

CONCLUSION

Self-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).

Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial

Patients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).

Factors Associated with Heart Failure Knowledge and Adherence to Self-Care Behaviors in Hospitalized Patients with Acute Decompensated Heart Failure Based on Data from "the Weak Heart" Educational Program

PURPOSE

As insufficient adherence to recommendations is a major cause of poor health outcomes in patients with heart failure (HF), it is important to identify the factors that improve disease knowledge and self-care behaviors. We aimed to identify factors associated with HF knowledge and self-care behaviors in patients hospitalized due to acute decompensated heart failure (ADHF) in Poland.

PATIENTS AND METHODS

This was a secondary analysis of data from a multi-center, prospective, non-randomized educational program named "The Weak Heart", which was conducted in 14 cardiology centers in Poland. The level of HF knowledge was assessed using a questionnaire developed by the research team, and self-care behaviors were evaluated using the European Heart Failure Self-care Behaviour Scale (9-EHFScBS) questionnaire.

RESULTS

The study included 259 patients admitted to the hospital with ADHF. The mean HF knowledge and 9-EHFScBS questionnaire scores were 8.25± 4.34 and 25.2±9.5, respectively. The patients' level of education (P = 0.002), number of prior HF hospitalizations (P = 0.008), and previous disease education (P < 0.001) were independently associated with better HF knowledge. Age (P = 0.03) and disease education (P = 0.02) were independently associated with self-care behaviors.

CONCLUSION

The adherence to self-care recommendations among patients with ADHF is insufficient. Disease education positively influenced both HF knowledge and self-care abilities. To improve patients' adherence to HF recommendations, well-designed models of education based on HF management guidelines should be implemented.

Exploring the potential of acceptance and commitment therapy model in self-care behaviour in persons with heart failure

Aim

This study examined the interaction among cognitive fusion, mindfulness and committed action on the self-care behaviour in person with heart failure as guided by the acceptance and commitment therapy model.

Design

An exploratory cross-sectional design was used.

Method

Participants with heart failure from in-patients setting (N = 165) were recruited from two major regional hospitals. Data were collected using self-report questionnaires of the study variables and demographic characteristics. Data were analysed using Hayes SPSS process macros.

Results

Based on the acceptance and commitment therapy model propositions, all main and interaction effects, except for cognitive fusion, were significant. The current study showed that the main effect of the study variables on self-care behaviour was insufficient and adding complex interactions between these variables improved the model fit, as it was suggested by the acceptance and commitment therapy model.

The Role of Health Literacy in Postpartum Weight, Diet, and Physical Activity

Background: Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women. Methods: We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes. Results: Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) −2.46 kg; 95% confidence interval (CI) from −3.65 to −1.27) and increase in physical activity (standardized mean difference (SMD) 0.61; 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity. Conclusions: Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported.

Self-care behavior: a new insight of the role of impulsivity into decision making process in persons with heart failure

Background

Self-care behavior has been reported to be below optimum in persons with heart failure, while the underlying decision making is not well understood. The Hot/Cool System model is a psychological model that may have potential applications in decision making process in persons with heart failure. The aim of this study was to examine the decision making process in self-care behavior in persons with heart failure in the light of the Hot/Cool System model.

Methods

We used the Hoot/Cool System Model to guide this study. Participants with heart failure from in-patients setting (N = 107) were recruited. Data were collected using self-report questionnaires. Moderated mediation analysis was used to study complex relationships among study variables.

Results

The current study showed that impulsivity and perceived stress were negatively associated with self-care behavior. The results also showed that self-care confidence and impulsivity significantly predict self-care maintenance. The moderated mediation analysis revealed that self-care confidence mediated the relationship between impulsivity and self-care maintenance at lower levels of perceived stress, but not at higher levels of perceived stress.

Conclusion

Our findings revealed that persons with heart failure tend to make impulsive choices that may negatively affect disease progression under higher levels of perceived stress. This study provides foundational knowledge regarding the decision making process in persons with heart failure.

Patient-Reported Compliance in older age patients with chronic heart failure

METHODS AND RESULTS

475 patients (including 222 women), mean age 69.7±7.7, with HF, hospitalized at University Hospital between January and December 2018 were included in the study. The patients were selected by a physician specializing in cardiology. A cardiac nurse assessed the non-pharmacological level of compliance using the Revised Heart Failure Compliance Questionnaire (RHFCQ). The socio-clinical data were obtained from medical records. The majority of the study group were patients in NYHA II (62.4%) and NYHA III (28.3%), the mean duration of the disease was 6.2±4.9 years, and the mean ejection fraction of the left ventricle (EF) was 48.6±12.6. The average level of compliance in the study group measured on a scale from 0 to 4 points was: median = 2.7, IQR [2.32; 3.25]. Only 6.9% of the respondents adhere to recommendations totally (all dimensions of RHFCQ). In univariate analysis, predictors negatively affecting compliance were: female gender (rho = -0.325), age below 65 years (rho = -0.014)), loneliness (rho = -0.559), number of hospitalizations (rho = -0.242), higher stage of NYHA (rho = -1.612), co-morbidities (rho = -0.729), re-hospitalizations (rho = -0.729), beta-blockers treatment (rho = -1.612) and diuretics treatment (rho = -0.276). Factors positively affecting compliance were: EF≥45% (rho = 0.020) and treatment with ACEI/ARB (rho = 0.34), whereas compliance was negatively affected by-EF<45% (β = 0.009). Independent predictors influencing the level of compliance were: loneliness (β = -1.816), number of hospitalizations (β = -0.117), NYHA III and IV and number of co-morbidities (β = -0.676).

CONCLUSIONS

Patients with HF do not adhere to therapeutic recommendations. The lowest compliance levels were found for exercise and daily weighing, and the highest for follow-up appointment-keeping and medication. Loneliness and age are the strongest predictors which influence the level of compliance.

Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial

Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting. Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures. Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B₁₂ levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period. Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities.

Relationship between self-care behaviors and quality of life in patients with heart failure

Background

It has been generally agreed that cardiac failure is one of the common and devastating diseases due to its morbidity, mortality and rates of disability. Moreover, it has negative impacts on quality of life among sufferers. Meanwhile, improving quality of life among heart failure patients is essential. It can be suggested that people with self-care ability have a better quality of life. However, this issue may be affected by some cultural issues. Regarding a paucity of information on this aspect in Iran, this study aims to explore the relationship between self-care behaviors and quality of life in patients with heart failure.

Methods

This study is carried out using a descriptive - analytical method. The sample size consists of 77 patients who consented to participate in the study and had ejection fraction <40%. The tools were demographic checklist, European heart failure self-care behavior scale, and SF-36 quality of life questionnaire. Data was gathered from the heart center of Imam Ali in Kermanshah-Iran. Data analysis was done using independent t-test, Mann Whitney, ANOVA, and Kruskal-Wallis tests by SPSS-24 software.

Findings

The study sample was 77 participants, of which 45 were female and 51 lived in an urban area. The mean of self-care score was 39.42 ± 7.04, and most of the patients (67.5%) were in moderate level. The mean and SD of quality of life was estimated as 38.45 ± 17.28. The spearman correlation test showed no correlation between self-care and quality of life. However there was a correlation between marital status and self-care ability, in which it shows the higher scores in unmarried people (K2 = 7.75, P = 0.021), and the results indicated better quality of life in male (t = 2.68, P = 0.009), educated patients at the level of university (F = 7.60, P < 0.001), free job (F = 6.21, P < 0.001) and lived in the urban area (Z = 2.05, P = 0.04).

Conclusion

In this study, there is no correlation between self-care behaviors and quality of life in which, this may be attributed to Iranian cultures and perspectives such as valuing live with the children and importance of their attention to elderly patients, which demanded more studies.

Factors Affecting Health Care Engagement of Patients With End-Stage Heart Failure: An Exploratory Survey Study

Background. The decision to receive a permanent left ventricular assist device (LVAD) to treat end-stage heart failure (HF) involves understanding and weighing the risks and benefits of a highly invasive treatment. The goal of this study was to characterize end-stage HF patients across parameters that may affect their decision making and to inform the development of an LVAD decision support tool. Methods. A survey of 35 end-stage HF patients at an LVAD implant hospital was performed to characterize their information-seeking habits, interaction with physicians, technology use, numeracy, and concerns about their health. Survey responses were analyzed using descriptive statistics, grounded theory method, and Bayesian network learning. Results. Most patients indicated an interest in using some type of decision support tool (roadmap of health progression: 46%, n = 16; personal prognosis: 51%, n = 18; short videos of patients telling stories of their experiences with an LVAD: 57%, n = 20). Information patients desired in a hypothetical decision support tool fell into the following topics: prognoses for health outcomes, technical information seeking, expressing emotions, and treatment decisions. Desire for understanding their condition was closely related to whether they had difficult interpreting their electronic medical record in the past. Conclusions. Most patients reported interest in engaging in their health care decision making and seeing their prognosis and electronic health record information. Patients who were less interested in their own treatment decisions were characterized by having less success understanding their health information. Design of a decision support tool for potential LVAD patients should consider a spectrum of health literacy and include information beyond the technical specifications of LVAD support.

Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia

INTRODUCTION

Patients with end-stage renal disease (ESRD) face multifaceted problems arising from complications of the disease and dialysis that require consistent and, effective self-management from the patients' side, on top of the management offered by health care professionals. However, little is known about the level of self-management and influencing factors among patients with ESRD undergoing hemodialysis in the study area. Therefore, the aim of this study was to assess self-management and associated factors of patients with ESRD undergoing hemodialysis at health facilities in Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional survey was used to recruit 169 patients with ESRD undergoing hemodialysis from six private health facilities between March and April 2016. Data were collected using an interviewer-administered structured questionnaire inquiring about patients' self-management and associated factors. Data were entered into EpiData Version 3.1 and analyzed using the descriptive, correlation, and logistic regression using the SPSS Version 22.0 statistical software.

RESULTS

The mean age of the patients was 49.86±15.58 years. The majority of the respondents (69.8%) were male, and 65.7% of them were married. Half of the respondents (50.3%) had diploma and above educational level. The great majority of the respondents (93.5%) were on hemodialysis for less than 5 years, and 53.3% of them underwent dialysis twice a week. More than half (57.4%) of the patients had low levels of self-management. There were statistically significant positive associations between self-management and education (adjusted OR [AOR] =6.25, 95% CI =1.40, 27.85), knowledge (AOR =5.5, 95% CI =2.15, 14.03), and self-efficacy (AOR =4.73, 95% CI =1.95, 11.48), while there were statistically significant negative associations between self-management and anxiety (AOR =3.19, 95% CI =1.28, 7.95) and depression (AOR =2.68, 95% CI =1.01, 7.05, P<0.05).

CONCLUSION

Patients' education, knowledge, self-efficacy, anxiety, and depression were found to be independent predictors of self-management.

CKD Self-management: Phenotypes and Associations With Clinical Outcomes

BACKGROUND

To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort.

PREDICTORS

CKD self-management behavior phenotypes.

OUTCOMES

CKD progression, atherosclerotic events, heart failure events, death from any cause.

MEASUREMENTS

Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A1c concentration (if diabetic); Cox proportional hazards models.

RESULTS

3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P < 0.05). Phenotype II was associated with atherosclerotic events and death among those with and without diabetes.

LIMITATIONS

No consensus definition of CKD self-management; limited to baseline behavior data.

CONCLUSIONS

There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management.

Patterns of heart failure symptoms are associated with self-care behaviors over 6 months

BACKGROUND

Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time.

AIMS

To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time.

METHOD

Latent mixture analysis was used to identify subgroups based on physical symptoms of dyspnea, sleepiness and edema (using the heart failure somatic perception and Epworth sleepiness scales). Growth modeling was used to determine if symptom subgroups were associated with self-care behaviors (using the self-care in heart failure index) over 6 months. Sociodemographic and clinical variables predicting the likelihood of subgroup membership were identified using logistic regression.

RESULTS

The sample ( n=146) was on average 57 years old, 70% were men and 59% had class III/IV heart failure. Two symptom subgroups were identified (entropy 0.91): a high symptom group ( n=24; 16%) with no significant change in symptoms over time (high sustained), and a low symptom group ( n=122; 84%) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (odds ratio (OR) 3.67, P=0.023) and patients with more depressive symptoms (OR 1.16, P=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin-angiotensin-aldosterone system agent were less likely to be in the high symptom group (OR 0.17, P=0.015).

CONCLUSION

Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. The results of this study support symptoms as an important driver of self-care behaviors.

The Most and the Least Performed Self-Care Behaviors Among Patients With Heart Failure in Jordan

Assessing self-care is important aspects among patients with heart failure. However, few studies were conducted to assess self-care among patients with heart failure in Jordan. Therefore, this study aimed to assess the most and the least performed maintenance self-care behaviors and to examine the relationship between maintenance self-care behaviors and selected sociodemographics. A cross-sectional design utilizing a convenience sample of 226 patients with heart failure was used. The maintenance self-care mean was 53.89 and considered below the clinical target level (≥70). Asking for low salt item and performing physical exercises were the most performed self-care behaviors, while "trying to avoid getting sick" and "checking ankles for swelling" were the least performed self-care behaviors. Limited self-care behaviors indicated the need to implement cardiac education that may improve self-care behaviors. Cardiac education should target mainly patients with low income, low educational level, elderly, living alone, unemployed, and who are using traditional treatment.

Cognitive deficits and self-care behaviors in elderly adults with heart failure

Introduction

Elderly adults with heart failure (HF) may have problems with self-care behaviors because of cognitive deficits. Self-care deficits have been found to be significantly associated with negative health care outcomes among HF patients. The aim of this paper was to assess cognitive deficits and the level of self-care ability in elderly patients with HF, and to determine if a relationship exists between cognitive deficits and self-care.

Materials and methods

The study included 270 elderly patients (mean age: 72.5 years) with HF. We used the Mini Mental State Examination Scale (MMSE) to evaluate cognitive functioning, and the European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), to evaluate self-care behaviors. Associations between the variables were examined using multiple regression analysis.

Results

Lower scores in both MMSE and EHFScBS-9 questionnaires were correlated with older age, living alone, lower education, longer duration of illness, higher number of rehospitalizations, as well as lower left ventricular ejection fraction and higher New York Heart Association (NYHA) class. The multiple regression analysis was used for evaluation of the impact of the following predictors: MMSE score, age, duration of illness, ejection fraction, number of hospitalizations, sex, residence, education, relationship status, and NYHA class on EHFScBS-9 score.

Conclusions

Elderly patients with HF may have worse self-care behaviors because of their cognitive deficits. Age was the strongest predictor of worse MMSE scores. Multidisciplinary health teams should pay attention to the special needs of elderly patients who live with their illness for many years and have no social support because of living alone.

Exploring Symptom Clusters in People With Heart Failure

Patients with heart failure (HF) experience multiple symptoms or symptom clusters. The purposes of this study were to (a) determine if distinct latent classes of HF symptoms could be identified, and (b) explore whether sociodemographic and clinical characteristics influenced symptom cluster membership. A total of 4,011 HF patients recruited from outpatient setting completed the Minnesota Living With Heart Failure Questionnaire (MLHFQ), including five physical symptoms (edema, shortness of breath, fatigue-increased need to rest, fatigue-low energy, and sleep difficulties) and three psychological symptoms (worrying, feeling depressed, and cognitive problems). Four distinct classes using latent class profile analysis were identified: low distress (Class 1), physical distress (Class 2), psychological distress (Class 3), and high distress (Class 4). Significant differences among the four latent classes were found for age, education level, and comorbidities. Symptom clusters are useful for recognition of HF symptoms, allowing for the development of strategies that target symptom groups.

Self-care behavior and related factors in older patients with uncontrolled hypertension

BACKGROUND

Effective self-care behavior can help reduce hypertension complications, but the rate of engagement in self-care behavior is relatively low among elderly patients.

OBJECTIVES

To examine levels of self-care and factors affecting self-care among elderly patients with uncontrolled hypertension compared with those with controlled hypertension.

DESIGN

Cross-sectional survey.

METHODS

A total of 255 elderly patients were selected to measure hypertensive patients' self-care behavior and self-efficacy, knowledge of hypertension management, family support, and perceived severity of hypertension as well as their depression levels.

RESULTS

The uncontrolled hypertension group showed lower scores for self-care behavior and self-efficacy than the controlled hypertension group. Only self-efficacy significantly affected self-care behavior in the latter group, whereas self-efficacy, education level, and family support affected self-care behavior in the former group.

CONCLUSIONS

The study results indicated that strategies for uncontrolled hypertension elderly patients should consider patients' educational, family support, and self-efficacy levels in order to improve their self-regulation.

Perceived social support and self-care in patients hospitalized with heart failure

BACKGROUND

Rehospitalization of heart failure patients is often considered the result of inadequate self-care yet only one study documents superior outcomes with better self-care.

AIMS

If inadequate self-care is related to hospitalizations, then hospitalized heart failure patients should have lower self-care skills than non-hospitalized patients. The purpose of this study was to evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure. The self-care of heart failure index (SCHFI) and medical outcomes study of social support (MOS-SS) were the key instruments used in the research.

METHODS AND RESULTS

This descriptive study used t tests and multiple regression to analyze the data. Results were compared with non-hospitalized heart failure patients in another study. Perceived social support ( t=-4.007, df=211, P<0.001) and self-care maintenance ( t=-3.343, df=220, P<0.002) scores were lower in the hospitalized participants than the comparison group. Self-care confidence was the only variable significantly related to perceived social support ( β=0.210, t=2.210, P<0.30).

CONCLUSIONS

This study supports the premise that heart failure rehospitalizations are related to inadequate self-care.

Practical Care Support During the Early Recovery Period After Acute Coronary Syndrome

OBJECTIVE

To describe the prevalence and predictors of receipt of practical support among acute coronary syndrome (ACS) survivors during the early post-discharge period.

METHOD

406 ACS patients were interviewed about receipt of practical (instrumental and informational) support during the week after discharge. Demographic, clinical, functional, and psychosocial predictors of instrumental and informational practical support were examined.

RESULTS

81% of participants reported receiving practical support during the early post-discharge period: 75% reported receipt of instrumental support and 51% reported receipt of informational support. Men were less likely to report receiving certain types of practical support, whereas married participants and those with higher education, impaired health literacy, impaired activities of daily living, and in-hospital complications were more likely to report receiving certain types of practical support.

CONCLUSION

Receipt of practical support is very common among ACS survivors during the early post-discharge period, and type of support received differs according to patient characteristics.

The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial

BACKGROUND

Heart failure is associated with exacerbated symptoms such as dyspnea and edema and results in frequent hospitalization and a poor quality of life. With the adoption of a comprehensive nursing care and follow-up program, patients with heart failure may exhibit improvements in their self-care capabilities and their hospitalizations may be reduced.

OBJECTIVE

The purpose of this study was to examine the effect of a nursing care and follow-up program for patients with heart failure on self-care, quality of life, and rehospitalization.

DESIGN AND SETTING

This research was conducted as a single-center, single-blind, randomized controlled study at the heart failure outpatient clinic of a university hospital in Turkey.

PARTICIPANTS

A total of 90 patients with heart failure were randomly assigned into either the specialized nursing care group (n=45) or the control group (n=45).

METHODS

The nursing care and follow-up program applied in the intervention group was based on the Theory of Heart Failure Self-care. Data were collected at the beginning of the trial, and at three and six months after the study commenced. Self-care of the patients was assessed by the Self-Care of Heart Failure Index. Quality of life was assessed with the "Left Ventricular Dysfunction Scale". Rehospitalization was evaluated based on information provided by the patients or by hospital records.

RESULTS

A statistically significant difference was found between the intervention and control group with respect to the self-care and quality of life scores at both three and six months. While the intervention group experienced fewer rehospitalizations at three months, no significant differences were found at six months.

CONCLUSION

The results obtained in this study show that the nursing care and follow-up program implemented for patients with heart failure improved self-care and quality of life. Although there were no significant differences between the groups at six months, fewer rehospitalizations in the intervention group was considered to be an important result.

Self-care in rural residents with heart failure: What we are missing

BACKGROUND

As heart failure (HF) is a progressive, debilitating condition, life-long self-care is required to achieve good outcomes. Rural residents with HF encounter more challenges with adherence to self-care than their urban counterparts because of rural-urban inequalities related to socioeconomic resources and access to health care. To date, investigators have focused on self-care in HF patients in urban settings, although factors related to self-care may be different between rural and urban residents.

AIM

The aim of this study was to explore the variables related to self-care in HF patients living in rural areas.

METHODS

A total of 580 patients in the USA were included in this analysis. We included 12 variables reflecting four aspects that affect patients' decisions to perform self-care: health literacy, psychosocial status, current symptom status, and aging status. We measured self-care using the European Heart Failure Self-Care Scale-9.

RESULTS

Depressive symptoms (β = 0.28, 95% confidence interval (CI): 0.16 to 0.45), lower perceived control (β = -0.15, 95% CI: -0.32 to -0.08), better symptom status (β = -0.11, 95% CI: -0.13 to -0.003), and annual income of <$20,000 (β = 0.11, 95% CI: 0.38-2.97) were negatively associated with self-care in rural residents with HF. The model with 12 variables explained 7.1% of the variance in self-care.

CONCLUSIONS

The variables included in the model did not sufficiently explain self-care among rural dwellers with HF. Given that all variables in the model were intrapersonal-level factors, more investigations that incorporate interpersonal factors (e.g. cultural beliefs and access to care) are needed in order to improve our understanding of self-care in HF patients living in rural areas.

Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

Factors Related to Nonadherence to Low Sodium Diet Recommendations in Heart Failure Patients

Background: A low sodium diet is a cornerstone of nonpharmacologic therapy for heart failure patients. Although nonadherence is common, little is known about why heart failure patients fail to adhere to this diet.

Aims: The purpose of this study was to explore the experience of heart failure patients in following a low sodium diet.

Methods and results: We conducted a qualitative descriptive study with a convenience sample of 20 participants. Interviews were conducted and analyzed for themes. The data reflected three primary themes about nonadherence to the low sodium diet: lack of knowledge, interference with socialization, and lack of food selections. Participants expressed a need for details about low sodium food selection, food preparation, and rationale for the diet. Lack of knowledge also was manifested as diet confusion for participants who required additional dietary restrictions. Interference with socialization was manifested by patients' experiences with family conflict when family members ate high-sodium foods and difficulty eating out. The theme of lack of low sodium food selections was reflected by comments about limited food choices, and lack of palatability.

Conclusion: Researchers and clinicians need to consider patients' perceptions as they generate and evaluate interventions to increase adherence to a low sodium diet.

Associação entre autocuidado e reinternação hospitalar de pacientes com insuficiência cardíaca

RESUMO Objetivo: verificar associação entre o autocuidado e o número de reinternações hospitalares de pacientes com diagnóstico de insuficiência cardíaca (IC) descompensada, bem como testar a aplicabilidade de dois instrumentos de avaliação de autocuidado. Estudo longitudinal, realizado em um hospital de referência cardiológica do sul do Brasil. Método: foram incluídos 82 pacientes, com idade média de 61,85±12,33 anos, 57,3% do sexo masculino. O escore médio da avaliação de autocuidado encontrado pelas escalas European Heart Failure Self-care Behavior Scale e a Escala de Autocuidado para Pacientes com Insuficiência Cardíaca foi insatisfatório. Resultados: foi verificada uma média de 2,57±1,66 reinternações hospitalares no último ano por descompensação da IC. Houve correlação entre os escores de autocuidado com número de reinternações hospitalares por IC descompensada. Escolaridade e idade mostraram-se associadas ao autocuidado dos pacientes com IC. Conclusão: ambas as escalas avaliam o autocuidado de forma relevante, sendo correlacionados os seus índices.

Tailoring of self-management interventions in patients with heart failure

The effectiveness of heart failure (HF) self-management interventions varies within patients suggesting that one size does not fit all. It is expected that effectiveness can be optimized when interventions are tailored to individual patients. The aim of this review was to synthesize the literature on current use of tailoring in self-management interventions and patient characteristics associated with self-management capacity and success of interventions, as building blocks for tailoring. Within available trials, the degree to which interventions are explicitly tailored is marginal and often limited to content. We found that certain patient characteristics that are associated with poor self-management capacity do not influence effectiveness of a given intervention (i.e., age, gender, ethnicity, disease severity, number of comorbidities) and that other characteristics (low: income, literacy, education, baseline self-management capacity) in fact are indicators of patients with a high likelihood for success. Increased scientific efforts are needed to continue unraveling success of self-management interventions and to validate the modifying impact of currently known patient characteristics.

Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice

Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.

Predictors of heart failure self-care in patients who screened positive for mild cognitive impairment

BACKGROUND

Heart failure (HF) is associated with cognitive impairment, which could negatively affect a patient's abilities to carry out self-care, potentially resulting in higher hospital readmission rates. Factors associated with self-care in patients experiencing mild cognitive impairment (MCI) are not known.

OBJECTIVE

This descriptive correlation study aimed to assess levels of HF self-care and knowledge and to determine the predictors of self-care in HF patients who screen positive for MCI.

METHODS

The Montreal Cognitive Assessment was used to screen for MCI. In 125 patients with MCI hospitalized with HF, self-care (Self-care of Heart Failure Index) and HF knowledge (Dutch Heart Failure Knowledge Scale) were assessed. We used multiple regression analysis to test a model of variables hypothesized to predict self-care maintenance, management, and confidence.

RESULTS

Mean (SD) HF knowledge scores (11.24 [1.84]) were above the level considered to be adequate (defined as >10). Mean (SD) scores for self-care maintenance (63.57 [19.12]), management (68.35 [20.24]), and confidence (64.99 [16.06]) were consistent with inadequate self-care (defined as scores <70). In multivariate analysis, HF knowledge, race, greater disease severity, and social support explained 22% of the variance in self-care maintenance (P < .001); age, education level, and greater disease severity explained 19% of the variance in self-care management (P < .001); and younger age and higher social support explained 20% of the variance in self-care confidence scores (P < .001). Blacks, on average, scored significantly lower in self-care maintenance (P = .03).

CONCLUSION

In this sample, patients who screened positive for MCI, on average, had adequate HF knowledge yet inadequate self-care scores. These models show the influence of modifiable and nonmodifiable predictors for patients who screened positive for MCI across the domains of self-care. Health professionals should consider screening for MCI and identifying interventions that address HF knowledge and social support. Further research is needed to explain the racial differences in self-care.

Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure

Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (β = 34.265, R² = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care.

Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure

BACKGROUND

The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination.

OBJECTIVE

The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention.

METHODS

This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study.

RESULTS

The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale).

CONCLUSIONS

An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Frailty syndrome and self-care ability in elderly patients with heart failure

Background

Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty.

Methods

The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale.

Results

Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social).

Conclusion

The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.

Patient and disease characteristics associated with activation for self-management in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study

A substantial proportion of chronic disease patients do not respond to self-management interventions, which suggests that one size interventions do not fit all, demanding more tailored interventions. To compose more individualized strategies, we aim to increase our understanding of characteristics associated with patient activation for self-management and to evaluate whether these are disease-transcending. A cross-sectional survey study was conducted in primary and secondary care in patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and Chronic Renal Disease (CRD). Using multiple linear regression analysis, we analyzed associations between self-management activation (13-item Patient Activation Measure; PAM-13) and a wide range of socio-demographic, clinical, and psychosocial determinants. Furthermore, we assessed whether the associations between the determinants and the PAM were disease-transcending by testing whether disease was an effect modifier. In addition, we identified determinants associated with low activation for self-management using logistic regression analysis. We included 1154 patients (53% response rate); 422 DM-II patients, 290 COPD patients, 223 HF patients and 219 CRD patients. Mean age was 69.6±10.9. Multiple linear regression analysis revealed 9 explanatory determinants of activation for self-management: age, BMI, educational level, financial distress, physical health status, depression, illness perception, social support and underlying disease, explaining a variance of 16.3%. All associations, except for social support, were disease transcending. This study explored factors associated with varying levels of activation for self-management. These results are a first step in supporting clinicians and researchers to identify subpopulations of chronic disease patients less likely to be engaged in self-management. Increased scientific efforts are needed to explain the greater part of the factors that contribute to the complex nature of patient activation for self-management.