Abstract 13276: Dyad Gender and Relationship Quality Are Related to Heart Failure Self-care Maintenance

Background: Self-care, a process of health maintenance, monitoring and symptom management, improves morbidity and mortality in adults with HF. Caregivers are important in promoting patient self-care but little is known about the effect of relationship quality (RQ) on HF patient self-care, especially in same and mixed gender dyads. Aim: Quantify the contribution of dyadic gender and RQ on HF patient self-care maintenance. Methods: Secondary analysis of baseline data from a study of Italian adults with HF and their caregivers ( n =503). Dyads were enrolled to assess effectiveness of motivational interviewing on HF self-care maintenance measured with the Self-Care of Heart Failure Index v.6.2, validated in an Italian population. RQ was assessed with the Mutuality Scale, validated for HF patients and caregivers. Dyadic gender was categorized as Male-Male (M-M), Female-Male (Fpt-Mcg), Female-Female (F-F), and Male-Female (Mpt-Fcg; reference group). Univariate linear regression with backward elimination ( p <.05) was used to identify determinants of HF patient self-care maintenance. Results: The sample was 48% Mpt-Fcg, 27% F-F, 15% Fpt-Mcg, 10% M-M. Mpt-Fcg dyad patients were married (86%); with older (59±15 years), less educated (46% secondary or lower) spousal caregivers (66%). More F-F vs M-M patients lived alone (32% vs 4%). Determinants of better patient self-care were: living alone, receiving assistance for HF, better mental quality of life, patient and caregiver employment, caregiver married status, higher caregiver perceived social support, and more months caring for the patient. Dyad gender, RQ, and these covariates explained 23% of variance in patient self-care maintenance. Dyad gender independently contributed to self-care, but only for same gender dyads. Being in a M-M dyad was associated with higher patient self-care (ß=.52, p <.026). Better caregiver perception of RQ in both M-M and F-F dyads was associated with lower patient self-care (M-M: ß=-.97, p <.001; F-F: ß=-.55, p <.026). There were no significant interactions for patient RQ or mixed gender dyads. Conclusion: Dyadic relationship quality appears to be important for self-care, particularly in M-M dyads and should to be considered when working with HF patients and their caregivers.

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The influence of gender and race on heart failure self-care

Chronic Illness ◽

10.1177/1742395319843163 ◽

2019 ◽

pp. 174239531984316

Author(s):

Lucinda J Graven ◽

Laurie Abbott ◽

Sabrina L Dickey ◽

Glenna Schluck

Keyword(s):

Heart Failure ◽

Racial Differences ◽

Care Management ◽

Secondary Analysis ◽

Self Care ◽

Female Gender ◽

Maintenance Management ◽

Gender And Race ◽

Care Outcomes ◽

Univariate Analyses

Objectives To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care. Methods A secondary analysis of baseline data ( n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence. Results Univariate analyses indicated that Caucasians reported significantly better self-care maintenance ( p = 0.042), while non-Caucasians reported significantly better self-care management ( p = 0.003). Males had significantly higher self-care confidence scores versus women ( p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (β = −11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (β = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance. Discussion Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.

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Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120902317 ◽

2020 ◽

Vol 19 (5) ◽

pp. 421-432 ◽

Cited By ~ 2

Author(s):

Maria Liljeroos ◽

Naoko P Kato ◽

Martje HL van der Wal ◽

Maaike Brons ◽

Marie Louise Luttik ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Perceived Control ◽

Secondary Analysis ◽

Self Care ◽

Prevalence Of Depression ◽

Threshold Score ◽

Beneficial Impact ◽

Underlying Mechanisms ◽

The Impact

Background: Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. Aims: (1) To describe the trajectory of patients’ self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour. Methods: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour. Results: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05). Conclusion: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.

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Abstract 12062: Patient and Caregiver Heart Failure Symptom Response Behaviors in 364 Patient-Caregiver Dyads

Circulation ◽

10.1161/circ.130.suppl_2.12062 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Julie T Bidwell ◽

Ercole Vellone ◽

Karen S Lyons ◽

Shirin O Hiatt ◽

Rosaria Alvaro ◽

...

Keyword(s):

Heart Failure ◽

Social Support ◽

Relationship Quality ◽

Nyha Class ◽

Secondary Analysis ◽

Adult Child ◽

Patient Health ◽

Symptom Response ◽

Recognition And Response ◽

Response Behaviors

Introduction: Recognition and response to symptoms of heart failure (HF) is critical to reducing the risk of hospitalization and mortality. Although many patients have support from caregivers, little is known about caregivers’ contributions to HF symptom response behaviors. We hypothesized that patient-, caregiver-, and dyad-level factors would be associated with better symptom response behaviors. Methods: This was a secondary analysis of data on 364 Italian HF patient-caregiver dyads. HF symptom response behaviors were measured using patient and caregiver versions of the Self-Care of Heart Failure Index (0-100; higher = better). Health status (SF-12) and relationship quality (single item) were collected from patients and caregivers. Patient cognition and comorbidities were measured using the MMSE and Charlson Index. Caregiver social support was measured with the Carers of Older People in Europe Index. Hospitalizations were abstracted from the medical record. Multilevel modeling was used for all analyses. Results: Patients were older (age 76.3±10.8 years), predominantly male (57.3%) and most had NYHA Class II/III HF (72.2%). Caregivers were younger (age 57.7±14.6 years), and most were female (51.7%) and adult child (53.6%) or spousal (34.0%) caregivers. Symptom response behaviors were poor in patients (49.1±19.6) and caregivers (54.7±18.3). Patient gender (male β=-4.60±1.92, p<0.05), better cognition (β=0.40±0.19, p<0.05), worse caregiver health (β=-0.43±0.14, p<0.01), and higher relationship quality (β=2.28±0.83, p<0.01) were significant determinants of better patient symptom response. Nonspousal relationship (β=6.62±1.96, p<0.001), fewer patient comorbidities (β=-2.32±0.79, p<0.01), better patient health (β=0.41±0.12, p=0.001), more hospitalizations (β=3.06±1.41, p<0.05), higher relationship quality (β=2.12±0.84, p<0.01), and higher caregiver social support (β=1.09±0.43, p<0.05) were significant determinants of better caregiver symptom response. Conclusions: Combinations of individual and relationship factors were significant determinants of patient and caregiver responses to HF symptoms. Assessment of patient and caregiver as a dyad may be useful in evaluating risk for poor management of HF symptoms.

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Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial

BMJ Open ◽

10.1136/bmjopen-2018-025525 ◽

2019 ◽

Vol 9 (8) ◽

pp. e025525

Author(s):

Chantal F Ski ◽

Martje H L van der Wal ◽

Michael Le Grande ◽

Dirk J. van Veldhuisen ◽

Ivonne Lesman-Leegte ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Depressive Symptoms ◽

The Netherlands ◽

Clinical Outcomes ◽

Secondary Analysis ◽

Self Care ◽

Patients With Heart Failure ◽

All Cause Mortality

ObjectiveTo identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke.Design and participantsA secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.SettingSeventeen hospitals located across the Netherlands.Outcomes measuresDepressive symptoms (Centre for Epidemiological StudiesDepressionScale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years.ResultsCompared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years.ConclusionsPatients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.

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Sociodemographic Indictors of Social Position and Self-care Maintenance in Adults with Heart Failure

Clinical Nursing Research ◽

10.1177/1054773821995593 ◽

2021 ◽

pp. 105477382199559

Author(s):

Foster Osei Baah ◽

Jesse Chittams ◽

Beverly Carlson ◽

Kristen A. Sethares ◽

Marguerite Daus ◽

...

Keyword(s):

Heart Failure ◽

Marital Status ◽

Secondary Analysis ◽

Self Care ◽

Descriptive Study ◽

Social Position ◽

Sociodemographic Characteristics ◽

Cross Sectional ◽

Backward Elimination ◽

The Relationship

Social determinants of health (SDH) are known to influence health. Adequate self-care maintenance improves heart failure (HF) outcomes. However, the relationship between self-care maintenance and SDH remains unclear. Explore the relationship between sociodemographic indicators of social position and self-care maintenance in adults with HF. This was a secondary analysis of data from a cross-sectional descriptive study of 543 adults with HF. Participants completed the Self-Care of HF Index and a sociodemographic survey. We used multiple regression with backward elimination to determine which SDH variables were determinants of self-care maintenance. Marital status ( p = .02) and race ( p = .02) were significant determinants of self-care maintenance. Education ( p = .06) was highest in Whites (35.6%). These variables explained only 3.8% of the variance in self-care maintenance. Race, education, and marital status were associated with HF self-care maintenance. SDH is complex and cannot be explained with simple sociodemographic characteristics.

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Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.121.007956 ◽

2021 ◽

Author(s):

William B. Stubblefield ◽

Cathy A. Jenkins ◽

Dandan Liu ◽

Alan B. Storrow ◽

John A. Spertus ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Health Status ◽

Usual Care ◽

Acute Heart Failure ◽

Kansas City ◽

Secondary Analysis ◽

Self Care ◽

Symptom Frequency ◽

Emergency Department Discharge

Background: We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. Methods: Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days. Results: There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55–70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33–64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12–9.68; P =0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01–2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46–3.90]) subdomains. Conclusions: In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02519283.

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Memory predicted self-care maintenance in patients with heart failure among cognitive functions: Results from a structural equation model

10.21203/rs.3.rs-809593/v1 ◽

2021 ◽

Author(s):

JinShil Kim ◽

Sun Hwa Kim ◽

Jae Lan Shim ◽

Seon Young Hwang

Keyword(s):

Heart Failure ◽

Structural Equation Model ◽

Structural Equation ◽

Memory Function ◽

Secondary Analysis ◽

Self Care ◽

Equation Model ◽

Cognitive Domain ◽

Neuropsychological Screening ◽

Patients With Heart Failure

Abstract Background: To explain the direction of specific cognitive function training that could prevent potential self-care deficits, the cognitive domain that affects self-care behaviours in patients with heart failure (HF) should be identified. This study aimed to confirm the relationship between major potential variables affecting self-care maintenance behaviours of patients with HF. The study also aimed to determine which cognitive domain predicts self-care maintenance among patients with HF. Methods: This descriptive study involved a secondary analysis using data of 201 patients with HF from two observational studies in three Korean hospitals. The structural equation model using AMOS version 24.0 was constructed to assess the relationships among the variables. The Seoul Neuropsychological Screening Battery was used to assess global cognition, immediate/delayed memory, and executive function, and the Self-Care of Heart Failure Index v.6.2. was used for self-care confidence and maintenance. Results: Self-care maintenance was affected by memory function with a significant direct effect (β=.43, p=.006), as well as self-care confidence (β=.70, p<.001). Memory function and global function indirectly affected self-care maintenance through self-care confidence (β=-.37, p=.002; β=.14, p=.030). Depressive symptoms also had an indirect effect through self-care confidence on self-care maintenance (β=-.21, p=.005). Conclusion: This study confirmed the need for periodic simple screening of the memory function and training to raise it in patients with HF, enhancing their self-care behaviours. It also suggests that supportive intervention is needed to enhance self-confidence as a mediator.

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Rethinking leisure time use metrics: Greater diversity in shared sibling leisure is associated with higher relationship quality during emerging adulthood

Journal of Social and Personal Relationships ◽

10.1177/0265407519867771 ◽

2019 ◽

Vol 37 (2) ◽

pp. 516-537

Author(s):

Eric K. Layland ◽

Camilla J. Hodge ◽

Mikala Glaza ◽

Jerrica O. Peets

Keyword(s):

Emerging Adulthood ◽

Relationship Quality ◽

Emerging Adults ◽

Sibling Relationship ◽

Age Difference ◽

Sibling Relationship Quality ◽

Taxonomic Analysis ◽

Gender Dyads ◽

Sibling Gender ◽

Mixed Gender

Leisure diversity—the total number of unique leisure categories shared within a sibling dyad—may vary according to sibling characteristics (e.g., sibling gender, age difference) and predict sibling relationship quality. Using triangulated lists, brief narratives, and focus groups, we constructed a taxonomy of shared sibling leisure in emerging adulthood and then calculated individual leisure diversity scores. The sample ( N = 185) included college-attending emerging adults with an average age of 20.1 years (35.7% female). Taxonomic analysis suggested 19 categories of shared sibling leisure. Analyses of variance indicated differences by dyadic gender composition in endorsement rates of select leisure categories and average levels of leisure diversity (lowest for mixed-gender dyads). Greater shared leisure diversity was associated with higher levels of affective (sister–sister dyads) and cognitive relationship quality (sister–sister and mixed-gender dyads). The association of leisure diversity with sibling relationship quality was strongest for sister–sister dyads and not significant for brother–brother dyads. Sibling dyads that include a sister are more likely to be impacted by the level of shared leisure diversity. The results of this study introduce leisure diversity as a metric for quantifying sibling leisure and support its potential as a means for understanding and impacting sibling relationship quality in emerging adulthood.

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Abstract 13356: Who Doesn't Respond to Motivational Interviewing for Heart Failure Self-care?

Circulation ◽

10.1161/circ.142.suppl_3.13356 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael A Stawnychy ◽

Valentina Zeffiro ◽

Paolo Iovino ◽

Ercole Vellone ◽

Barbara J Riegel

Keyword(s):

Heart Failure ◽

Sleep Quality ◽

Motivational Interviewing ◽

Sleep Disturbances ◽

Clinical Decision Making ◽

Treatment Options ◽

Intervention Group ◽

Secondary Analysis ◽

Self Care ◽

Significant Risk

Background: Motivational interviewing (MI) improves HF self-care yet fails to work for some patients. Lack of intervention response leaves clinicians and patients with fewer treatment options. Aim: Identify the characteristics of non-responders to MI in adults with HF. Methods: Secondary analysis of intervention group ( n =230) from MOTIVATE-HF trial. Study conducted in Italy to evaluate effectiveness of MI in improving HF self-care. Self-care maintenance measured with the validated Self-care of Heart Failure Index (SCHFI) v6.2 at baseline and 3 months from enrollment. Standardized scores range 0-100; changes > 7 pts from baseline are clinically significant. Participants dichotomized: MI non-responder (change in SCHFI < 7 pts) vs MI responder (change in SCHFI ≥ 7 pts). Logistic regression, adjusted for group differences (employment, income, living alone, HF etiology, baseline self-care, cognitive impairment, mutuality, medications, sleep quality, and HF health status), was used to estimate odds ratio with 95% confidence interval (OR [95% CI]) to identify determinants of non-response. Results: Half of the intervention group were non-responders to MI ( n =115) at 3 months. Non-responders were 72±13 years old and 53% male. Twice the number of non-responders were employed ( n =36 vs n =18, p <.005) and many reported ‘more than enough’ income (23% vs 13%, p <.046). They had more non-ischemic HF (79% vs 54%, p <.001), higher baseline self-care maintenance (48.8±19.2 vs 43.5±12.0, p <.009), and took fewer medications (6.1±3.0 vs 7.6±2.5, p <.009). Patients who responded to MI had worse HF quality of life ( p <.018), more sleep disturbances ( p <.042), and worse sleep quality ( p <.002). Significant risk factors for non-response were non-ischemic HF (2.606 [1.340-5.071], p <.005), fewer daily medications (0.829 [0.738-0.931], p <.002), and better baseline self-care maintenance (1.025 [1.001-1.050], p <.039). These variables explained 31% of HF self-care maintenance at 3 months (Nagelkerke R 2 =.309). Conclusion: MI may be less beneficial for patients with non-ischemic HF, lower medication burden, and relatively better self-care. Identifying characteristics of non-responders to MI in HF contributes to clinical decision making and personalized interventions.

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