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

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

2.12.5 - HF SELF-CARE



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.

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