The influence of gender and race on heart failure self-care

Individual and systems-related factors associated with heart failure self-care: a systematic review

BACKGROUND

Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 - Dec 2021) using the Socioecological Model as a review framework.

METHODS

An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review.

RESULTS

A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level.

CONCLUSION

Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.

Sociodemographic characteristics, lifestyle behaviors, and symptoms associated with fluid overload among non-hospitalized and community-dwelling older adults with heart failure: A population-based approach

BACKGROUND

Fluid overload is a major complication in patients with heart failure (HF) and the main reason for hospitalization. The purpose of the study was to explore the associations of fluid overload with sociodemographic characteristics, lifestyle behaviors, and symptoms among non-hospitalized and community-dwelling older adults with HF using large population data.

METHODS

Descriptive and multivariate analyses were conducted on the Health and Retirement Study 2016.

RESULTS

Fluid overload was prevalent in almost half of the sample. Female older adults with HF were more likely to have fluid overload (OR:1.43, p = 0.037) as well as being Black (OR:1.40, p = 0.041). Higher physical activity scores were associated with less likelihood of having fluid overload (OR:0.99, p = 0.025). Symptoms of shortness of breath (OR=2.18, p = 0.001), pain (OR=1.82, p < 0.001), and fatigue (OR=1.45, p = 0.025) were significantly associated with fluid overload.

CONCLUSION

Female and Black community-dwelling older adults with HF are at higher risk of fluid overload. Symptoms of shortness of breath, pain, and fatigue are significant manifestations of fluid overload. Effective patient-centered interventions to promote fluid flow via physical activity may help older adults with HF manage fluid overload and alleviate associated symptoms.

Factors associated with caregivers' contribution to self-care in heart failure

OBJECTIVE

to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution.

METHOD

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

RESULTS

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care.

CONCLUSION

the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Race Moderates the Relationship Between Perceived Social Support and Self-care Confidence in Patients With Heart Failure

BACKGROUND

African Americans are at the highest risk of developing heart failure (HF) compared with other races and are hospitalized at 7 to 8 times the rate of Whites. Poor overall self-care, low self-care confidence, and lower levels of perceived social support are factors related to increased risk for hospitalizations in HF. Yet, limited evidence is available regarding the factors that may differentially impact self-care confidence by race in patients with HF.

OBJECTIVE

The aim of this study was to examine to what extent race moderates the relationship between perceived social support and self-care confidence.

METHOD

This is a secondary analysis of cross-sectional data from African American and White patients with HF in North America (n = 429). Patients completed the Multidimensional Scale of Perceived Social Support and the Self-Care Confidence Scale of the Self-Care of Heart Failure Index. A moderation analysis was conducted using hierarchal linear regression.

RESULTS

Sample mean age was 60.8 ± 11.5 years, 22.4% were African American, and 54.7% were in New York Heart Association class I or II. Moderation analyses yielded a significant interaction of perceived social support and race, showing White patients, not African Americans, have significantly different self-care confidence scores depending on level of social support: White, b = 0.224, 95% confidence interval [0.046-0.094], t = 5.65, and P < .001; African American, b = -0.776, 95% confidence interval [-0.049 to 0.060], t = 0.212, and P = .832.

CONCLUSIONS

Our findings show a variable effect of perceived social support on self-care confidence as a function of race, suggesting the need for further research to develop and test interventions tailored to race and levels of social support in HF.

Factores asociados a la contribución de los cuidadores para el autocuidado de la insuficiencia cardiaca

Resumen Objetivo: analizar la contribución del cuidador para el autocuidado en la insuficiencia cardiaca y las variables predictoras de esa contribución. Método: estudio transversal descriptivo y analítico, con la participación de 140 díadas (pacientes y cuidadores). La contribución para el autocuidado fue evaluada por medio del Caregiver Contribution to Self-Care of Heart Failure Index. Los cuidadores y pacientes fueron entrevistados separadamente para obtención de los datos. La regresión linear múltiple fue utilizada para verificar variables predictoras de la contribución del cuidador. Resultados: la puntuación media de contribución para el autocuidado de manutención fue 62,7 (DE=7,1), de administración fue 62,9 (DE=20,4) y de confianza fue 63,3 (DE=22,1). Las variables: número de medicamentos del paciente, cuidador tener parentesco con el paciente, percepción social del cuidador, calidad de vida relacionada a la salud del paciente y la confianza del cuidador en la contribución para el autocuidado, fueron predictoras de la contribución del cuidador para el autocuidado de manutención o de administración. Conclusión: la contribución del cuidador fue insuficiente. El apoyo social percibido por el cuidador, el cuidador tener o no parentesco con el paciente, el número de medicamentos utilizados por el paciente y la confianza del cuidador en contribuir para el autocuidado, son variables que deben ser consideradas para evaluar el riesgo de contribución insuficiente del cuidador.

Factors associated with caregivers’ contribution to self-care in heart failure

Objective:

to analyze the caregiver’s contribution to self-care in heart failure and the predictor variables of this contribution.

Method:

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

Results:

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient’s medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver’s confidence in contributing to self-care were predictors of caregiver’s contribution to maintenance or management self-care.

Conclusion:

the caregiver’s contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver’s confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Self-Care in Heart Failure Inpatients: What Is the Role of Gender and Pathophysiological Characteristics? A Cross-Sectional Multicentre Study

Heart failure is often characterised by low exercise capacity and a great impairment of performance in the activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. The aims of this study are to understand the relationship of gender and pathophysiological characteristics with self-care behaviour and to evaluate the self-care behaviour in a sample of Portuguese heart failure inpatients, using the Self-Care of Heart Failure Index (SCHFI). A cross-sectional multicentre study enrolling 225 heart failure inpatients from eight hospitals from Portugal was performed. At admission, each patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. A comparison between self-care behaviour with gender was performed. The patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% had reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance, self-care management and self-care confidence, respectively. Heart failure inpatients present inadequate levels of self-care behaviour. The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

Social determinants of health (SDH) are known to influence health. Adequate self-care maintenance improves heart failure (HF) outcomes. However, the relationship between self-care maintenance and SDH remains unclear. Explore the relationship between sociodemographic indicators of social position and self-care maintenance in adults with HF. This was a secondary analysis of data from a cross-sectional descriptive study of 543 adults with HF. Participants completed the Self-Care of HF Index and a sociodemographic survey. We used multiple regression with backward elimination to determine which SDH variables were determinants of self-care maintenance. Marital status (p = .02) and race (p = .02) were significant determinants of self-care maintenance. Education (p = .06) was highest in Whites (35.6%). These variables explained only 3.8% of the variance in self-care maintenance. Race, education, and marital status were associated with HF self-care maintenance. SDH is complex and cannot be explained with simple sociodemographic characteristics.