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Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up
Lee, C. Bidwell, Julie T. Paturzo, Marco Alvaro, Rosaria Cocchieri, Antonello Jaarsma, Tiny Stromberg, Anna Riegel, Barbara Vellone, Ercole
Lee, C.
Bidwell, Julie T.
Paturzo, Marco
Alvaro, Rosaria
Cocchieri, Antonello
Jaarsma, Tiny
Stromberg, Anna
Riegel, Barbara
Vellone, Ercole
Abstract
Background: Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF selfcare to clinical events. Objectives: To identify patterns of self-care behaviors in HF patients and their association with clinical events. Methods: This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n ¼ 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up. Results: Patients (mean age 71.8 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio ¼ 0.66 [0.46e0.96], p ¼ 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events. Conclusions: Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients
Keywords
Date
2018
Type
Journal article
Journal
Heart & Lung: the journal of acute and critical care
Book
Volume
47
Issue
1
Page Range
40-46
Article Number
ACU Department
School of Allied Health
Faculty of Health Sciences
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Mary MacKillop Institute for Health Research
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled