The relationship between self-care, long-term mortality, and heart failure hospitalization: insights from a real-world cohort study. (19th May 2021)

• Record Type: Journal Article
• Authors: Calero-Molina, Esther; Hidalgo, Encarna; Rosenfeld, Laia; Verdú-Rotellar, Jose Maria; Verdú-Soriano, Jose; Garay, Alberto; Alcoberro, Lidia; Jimenez-Marrero, Santiago; Garcimartin, Paloma; Yun, Sergi; Guerrero, Carmen; Moliner, Pedro; Delso, Cristina; Alcober, Laia; Enjuanes, Cristina; Comin-Colet, Josep
• Is Part Of: European journal of cardiovascular nursing. Volume 21:Number 2(2022)
• Page Start: 116
• Page End: 126
• Publication Date: 2021-05-19
• Subjects: Heart failure -- Self-care -- Mortality -- HF hospitalization -- Outcomes -- European self-care behaviour scale; Cardiovascular system -- Diseases -- Nursing -- Periodicals; Cardiovascular Diseases -- nursing -- Periodicals; Cardiology -- Periodicals; Nursing -- Periodicals; Vascular Diseases -- Periodicals; 610.7369105
• DOI: 10.1093/eurjcn/zvab011
• Languages: English
• ISSNs: 1474-5151

Abstract

Abstract: Aims: The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). Methods and results: We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988–0.997), P -value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981–0.996), P -value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988–0.998), P -value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991–0.999), P -value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201–2.127), P -value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114–1.923), P -value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140–1.923), P -value = 0.006] were all associated with higher risk of all-cause mortality. Conclusion: In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.