Poor heart failure symptom response is associated with an increased risk of death and emergent healthcare utilization

Self-care is a vital component of heart failure (HF) management. Self-care behaviors in HF include components such as maintenance (i.e. treatment adherence/symptom monitoring), management (i.e. the self-initiated response to symptoms) and consulting behaviors (i.e. consulting a provider when symptoms occur).

To identify distinct patterns of HF self-care that would be associated with clinical outcomes.

We examined HF self-care behaviors and clinical outcomes in a cohort of 459 Italian patients with HF. Self-care maintenance and management were measured using the Self-Care of HF Index and consulting behaviors were measured using a subscale of the European HF Self-care Behavior Scale. One year after enrollment we contacted patients/caregivers to collect data on patient outcomes. We used latent class mixture modeling to identify distinct patterns of HF self-care behaviors and Cox proportional hazard modeling to estimate the association between patterns of self-care and all-cause mortality or emergency room visit for HF as a composite endpoint.

Most patients were male (55%) and in NYHA class I/II (54%). The average age of the sample was 71.8 years. We identified 3 patterns of self-care: (1) Poor symptom response behaviors (worst in all behaviors; n=151 (32.9%)); (2) good symptom response (best at all behaviors; n=112 (24.4%)); and (3) asymptomatic (no symptoms and average self-care maintenance; n=196 (42.7%)). Over 1 year, 30% of participants died and 30% required emergency care for HF. Patients with poor symptom response had the highest event risk (event rate = 76.8%). After adjusting for other factors observed to be different across groups, patients with a good symptom response had a much lower event risk compared with those who had a poor symptom response (event rate = 55.4%; adjusted hazard ratio=0.59 (0.39–0.90), p=0.01). There was no difference in event risk comparing patients with poor symptom response and those who were asymptomatic at baseline (event rate = 65.3%).

HF patients who are poor in self-care are at higher risk for death or emergency room visits. Routine clinical assessment of self-care behaviors and more interventions targeting improving self-care is advocated to improve outcomes in patients with HF.