Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up.
Christopher S Lee, Julie T Bidwell, Marco Paturzo and 6 others
PMID 29054487WHAT IT FOUND
Italian heart failure patients who recognized symptoms and responded well were less likely than poor responders to die, need emergency care or be hospitalized for heart failure within 12 months.
Patients focused only on routine self-care had similar likelihood to poor responders.
Key findings
01Three self-care patterns were identified: poor symptom response (about 33%), good symptom response (24.4%), and maintenance-focused (42.7%).
02After adjustment, patients with good symptom response behaviors were much less likely than poor responders to die, need emergency care, or be hospitalized for heart failure.
03Maintenance-focused patients were as likely as poor responders to have these clinical events in adjusted models.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 459 of 575 patients who agreed to follow-up were reached, so the analysed group may not represent all consented patients. Clinical events were reported by phone by patients or caregivers, not verified from long-term medical records, so recall bias is possible. The cohort was recruited by convenience sampling in Italy, so results may not generalize to other countries or health systems. The analysis is observational: self-care patterns were associated with events, but it cannot show that improving self-care will reduce death, emergency visits or hospitalization. The follow-up sample differed from the parent cohort, including being slightly younger, having lower ejection fraction, and having more patients in NYHA class III/IV.
Declared interests
No conflicts of interest were declared.
The easy way to misread this
Do not conclude that routine heart failure self-care alone prevents death, emergency visits or hospitalization. Patients who were maintenance-focused had similar 12-month event likelihood to poor responders, and the study shows association, not that changing self-care will change outcomes.