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Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study.

ABSTRACT: Background:Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients' quality of life. Aims:The aims of this study were to describe self-care including the factors influencing self-care and the relationship between self-care and health-related quality of life in patients living with HF in Kathmandu, Nepal. Methods:We used a cross-sectional observational study design to measure self-care maintenance, self-care management, and self-care confidence using the Nepali Self-Care of Heart Failure Index. To analyze data, we used descriptive statistics, bivariate associations and regression modeling. Results:We recruited 221 patients with HF: mean age 57.5 ± 15.76 years, 62% male. The results in this sample indicated poor self-care maintenance (38.5 ± 11.56), management (45.7 ± 15.14), and confidence (40.9 ± 16.31). Patients with higher education were associated with higher self-care maintenance and management. Living alone and a better New York Heart Association functional classification for HF were related to higher self-care confidence. Higher social support was associated with better self-care. Self-care confidence was an independent predictor of self-care maintenance, management and health-related quality of life on adjusted analyses. Conclusion:Self-care was limited among patients living with HF in Nepal yet was associated with better quality of life. The study identified various sociodemographic and clinical factors related to self-care, which could be crucial while developing self-care interventions.

SUBMITTER: Koirala B

PROVIDER: S-EPMC7031642 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study.

Koirala Binu B Dennison Himmelfarb Cheryl R CR Budhathoki Chakra C Davidson Patricia M PM

Heliyon 20200217 2

<h4>Background</h4>Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients' quality of life.<h4>Aims</h4>The aims of this study were to describe ...[more]

PMID: 32149197

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Project description:BackgroundOlder patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design.MethodsWe assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class.ResultsParticipants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p < 0.001; r = 0.30, p < 0.001; and r = 0.24, p = 0.001, respectively); and between SPPB and KCCQ Physical and SF-12 Physical Scores (r = 0.20, p = 0.004, and r = 0.19, p = 0.007, respectively). Both 6MWD and SPPB were correlated with multiple components of the EuroQol-5D-5L. 6MWD was a significant, weak predictor of KCCQ Overall Score and SF-12 Physical Score (estimate = 0.05 ± 0.01, p < 0.001 and estimate = 0.05 ± 0.02, p = 0.012, respectively). SPPB was a significant, weak predictor of KCCQ Physical Score and SF-12 Physical Score (estimate = 1.37 ± 0.66, p = 0.040 and estimate = 0.54 ± 0.25, p = 0.030, respectively).ConclusionIn older, hospitalized ADHF patients, PF and QOL are both severely impaired but are only modestly related, suggesting that PF and QOL provide complementary information and assessment of both should be considered to fully assess clinically meaningful patient-oriented outcomes.

Project description:Persons with concomitant heart failure (HF) and diabetes mellitus (DM) have complicated, often competing, self-care expectations and treatment regimens that may reduce quality of life (QOL). This randomized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL, physical function, and physical activity (PA).Participants with HF and DM (n = 134; mean age 57.4 ± 11 years, 66% men, 69% minority) were randomized to usual care (control) or intervention. The control group received standard HF and DM educational brochures with follow-up telephone contact. The intervention group received education and counseling on combined HF and DM self-care (diet, medications, self-monitoring, symptoms, and PA) with follow-up home visit and telephone counseling. Measures included questionnaires for HF- and DM-specific and overall QOL, PA frequency, and physical function (6-min walk test [6MWT]) and were obtained at baseline and 3 and 6 months. Analysis included mixed models with a priori post hoc tests. Adjusting for age, body mass index, and comorbidity, the intervention group improved in HF total (P = .002) and physical (P < .001) QOL scores at 3 months with retention of improvements at 6 months, improved in emotional QOL scores compared with control at 3 months (P = .04), and improved in health status ratings (P = .04) at 6 months compared with baseline. The intervention group improved in 6MWT distance (924 ft to 952 ft; P = .03) whereas the control group declined (834 ft to 775 ft; F1,63 = 6.86; P = .01). The intervention group increased self-reported PA between baseline and 6 months (P = .01).An integrated HF and DM self-care intervention improved perceived HF and general QOL but not DM QOL. Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention. Further study of the HF and DM integrated self-care intervention on other outcomes, such as hospitalization and cost, is warranted.

Dataset Information

Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study.

Publications

Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study.

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