Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study

作者：Peters Klimm F^*; Freund T; Kunz C U; Laux G; Frankenstein L; Mueller Tasch T; Szecsenyi J

来源：European Journal of Cardiovascular Nursing, 2013, 12(2): 167-176.

DOI：10.1177/1474515112439964

• Self-care
• heart failure
• ambulatory care
• efficacy
• geriatrics
• quality of life
• depression
• self-reporting
• European HF Self-care Behaviour scale
• SF-36
• Kansas City Cardiomyopathy Questionnaire

Background: Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component.
Aims: The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF.
Methods: In a cross-sectional study of 318 patients with chronic systolic HF recruited in 48 German primary care practices, we evaluated the patient-reported European HF Self-care Behaviour scale (EHFScBs) assessments (range 12-60, where lower scores indicate better self-care). Potential determinants included socio-demographic (e. g. age, living status), clinical (e. g. NYHA class, LVEF, NT-proBNP levels, co-morbidities), behavioural (e. g. smoking and alcohol intake), psychosocial (SF-36 scales and KCCQ domains, e. g. quality of life and self-efficacy) and depression status (PHQ-D), plus previous health care utilisation. Mixed regression modelling was applied.
Results: Patients had a mean (SD) age of 69.0 (10.4) years and were 71% male. They had a good overall EHFScBs score of 24.7 (7.8) (n=274). In the final regression model (n=271), six determinants were retained (beta; descriptive p-value): self-efficacy (-0.24; <.001), age (-0.22; <.001), prosthetic heart valve (-0.14;.01), referrals to cardiologists (-0.14;.02), peripheral arterial disease (0.13;.03) and quality of life (0.16;.02).
Conclusion: In this exploratory cross-sectional study, the potential non-modifiable and modifiable risk factors and resources involved in patients' HF self-care were at the individual and organisational level. Self-efficacy and quality of life are potentially modifiable, so these could be targeted for improvement by enhancing patient motivation, HF education and further supporting a collaborative care approach.

• 出版日期2013-4