Patient-caregiver dyadic determinants of of self-care maintenance and self-care management in heart failure

Heart failure (HF) is a chronic syndrome that impairs quality of life (QOL) and requires tremendous
healthcare resource utilization. To improve outcomes, patients with HF should engage in selfcare behaviors to maintain stability (selfcare maintenance) and intervene to treat symptoms of HF exacerbations (selfcare management). Patients and caregivers are both involved in HF care; but, the determinants of selfcare maintenance and selfcare management in patientcaregiver dyads are largely unknown. The aim of this study was to identify patient, caregiver, and dyadlevel determinants of patient and caregiver contributions to selfcare maintenance and management.

A multivariate multilevel modeling was used to analyze data from an Italian multicenter crosssectional study of HF patients and their primary caregivers. The following measures were considered for analysis: patients’ and caregivers’ contributions to selfcare, quality of life, and sociodemographic characteristics; patients’ clinical conditions, activity of daily living (ADL), and cognition; and caregivers’ burden and social support. Patients and caregivers also rated the quality of their relationship.

A sample of 364 patientcaregiver dyads were considered. Patients and caregivers were 76±11 and 57±15 years old respectively. Patients were predominantly male (57%) and caregivers were predominantly female (52%). Most patients had NYHA class II and III (69%). Better patient selfcare maintenance was determined by lower patient physical QOL, more comorbid conditions, higher patient impairment in ADL, better cognition, fewer hospitalizations, worse HFspecific emotional QOL, female caregiver gender, better patientreported relationship quality, and better caregiver social support. Better caregiver selfcare
maintenance contribution was determined by longer HF duration and worse patient HFspecific emotional QOL. Better patient selfcare management was determined by patient female gender, better cognition, worse caregiver
physical QOL, and better patientreported relationship quality. Better caregiver selfcare management contribution was determined by better patient physical QOL, fewer comorbid conditions, greater number of hospitalizations, non spousal relationship, better caregiver reported          relationship quality and better caregiver social support.

A combination of patient, caregiver, and dyadic characteristics predicted both patient and caregiver contributions to selfcare. These characteristics can be used by practitioners to tailor interventions for HF-patient caregiver dyads.