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Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up
Oregon Health and Science University, OR 97201 USA.
Emory University, GA 30322 USA.
University of Roma Tor Vergata, Italy.
University of Roma Tor Vergata, Italy.
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2018 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 47, no 1, p. 40-46Article in journal (Refereed) Published
Abstract [en]

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 self care 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 = 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 = 0.66 10.46-0.96], p = 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. (C) 2017 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2018. Vol. 47, no 1, p. 40-46
Keywords [en]
Mortality; Heart failure; Prospective study; Self-care; Survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-143984DOI: 10.1016/j.hrtlng.2017.09.004ISI: 000418210000006PubMedID: 29054487OAI: oai:DiVA.org:liu-143984DiVA, id: diva2:1170235
Note

Funding Agencies|Center of Excellence for Nursing Scholarship, Rome, Italy

Available from: 2018-01-02 Created: 2018-01-02 Last updated: 2018-01-02

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Jaarsma, TinyStrömberg, Anna
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Division of Nursing ScienceFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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