Christopher S Lee1, Julie T Bidwell2, Marco Paturzo3, Rosaria Alvaro3, Antonello Cocchieri4, Tiny Jaarsma5, Anna Strömberg6, Barbara Riegel7, Ercole Vellone8. 1. School of Nursing, Oregon Health & Science University, Portland, OR, USA. 2. Emory University Nell Hodgson Woodruff, School of Nursing, Atlanta, GA, USA. 3. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. 4. Department of Nursing Professions, Catholic University, Rome, Italy. 5. Department of Social and Welfare Studies, University of Linköping, Linköping, Sweden. 6. Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden. 7. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. 8. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Electronic address: ercole.vellone@uniroma2.it.
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 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 [0.46-0.96], 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.
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 HFpatients (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 [0.46-0.96], 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.
Authors: Meghan Reading Turchioe; Lisa V Grossman; Dawon Baik; Christopher S Lee; Mathew S Maurer; Parag Goyal; Monika M Safford; Ruth M Masterson Creber Journal: J Am Geriatr Soc Date: 2020-03-10 Impact factor: 5.562
Authors: Jonathan P Auld; James O Mudd; Jill M Gelow; Karen S Lyons; Shirin O Hiatt; Christopher S Lee Journal: Eur J Cardiovasc Nurs Date: 2018-02-14 Impact factor: 3.908
Authors: Barbara Riegel; Sandra B Dunbar; Donna Fitzsimons; Kenneth E Freedland; Christopher S Lee; Sandy Middleton; Anna Stromberg; Ercole Vellone; David E Webber; Tiny Jaarsma Journal: Int J Nurs Stud Date: 2019-08-23 Impact factor: 5.837
Authors: Julie T Bidwell; Ercole Vellone; Karen S Lyons; Fabio D'Agostino; Barbara Riegel; Marco Paturzo; Shirin O Hiatt; Rosaria Alvaro; Christopher S Lee Journal: Eur J Cardiovasc Nurs Date: 2017-05-17 Impact factor: 3.908