Shir Lynn Lim1, Siew Pang Chan2,3, Kim Yee Lee1, Anne Ching1, Richard J Holden4,5, Karen F Miller6, Alan B Storrow6, Carolyn Sp Lam7,8, Sean P Collins6. 1. Department of Cardiology, National University Heart Center, Singapore. 2. Department of Medicine, National University of Singapore, Singapore. 3. Cardiovascular Research Institute, National University Heart Center, Singapore. 4. Department of BioHealth Informatics, Indiana University School of Informatics and Computing, USA. 5. Indiana University Center for Aging Research, USA. 6. Vanderbilt University Medical Center, USA. 7. Department of Cardiology, National Heart Center, Singapore. 8. Duke-NUS Graduate Medical School, Singapore.
Abstract
BACKGROUND: Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. METHODS: Acute heart failure patients were prospectively assessed with a standardized instrument comprising of 47 distinct self-care barriers. The multi-equation generalized structural equation model was used to evaluate for geographic differences in barriers experienced, and association of barriers with outcomes. RESULTS: Patient-related factors accounted for six out of 10 most prevalent self-care barriers among the 90 patients, with a median number of 11 barriers reported per patient. The Western patients reported a higher level of barriers when compared with their Eastern counterparts (median (interquartile range) 15 (9-24) versus 9 (4-16), p=0.001), after adjusting for demographics and co-morbidities. Many of these differences could be explained by geographic differences between the countries. There was no significant difference identified in all-cause mortality (19.4% versus 10.2%) and heart failure re-hospitalization (41.9% versus 45.8%) at six months between the groups. CONCLUSIONS: Self-care barriers are highly prevalent among acute heart failure patients, and differ substantially between East and West, but were not associated with geographic differences in outcomes.
BACKGROUND: Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. METHODS: Acute heart failure patients were prospectively assessed with a standardized instrument comprising of 47 distinct self-care barriers. The multi-equation generalized structural equation model was used to evaluate for geographic differences in barriers experienced, and association of barriers with outcomes. RESULTS: Patient-related factors accounted for six out of 10 most prevalent self-care barriers among the 90 patients, with a median number of 11 barriers reported per patient. The Western patients reported a higher level of barriers when compared with their Eastern counterparts (median (interquartile range) 15 (9-24) versus 9 (4-16), p=0.001), after adjusting for demographics and co-morbidities. Many of these differences could be explained by geographic differences between the countries. There was no significant difference identified in all-cause mortality (19.4% versus 10.2%) and heart failure re-hospitalization (41.9% versus 45.8%) at six months between the groups. CONCLUSIONS: Self-care barriers are highly prevalent among acute heart failure patients, and differ substantially between East and West, but were not associated with geographic differences in outcomes.
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