Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis.

The study observed associations only; it did not test whether self-care caused quality-of-life changes. Self-care and quality of life were measured by patient self-report, so they may not match actual behaviour or experience. Anxiety was measured with only two items, and the follow-up was 18 months, which may be too short to detect meaningful changes. Patients aged 80 years or older, those with diastolic heart failure, recent heart attack or hospitalisation, serious psychiatric illness, or limited Dutch were excluded, so results may not apply to those groups. More patients with worse illness severity, lower education and higher comorbidity dropped out, and dropouts had worse quality of life before leaving, which may bias the remaining sample. The paper describes psychological distress as part of the self-care association but did not formally test mediation.

The authors declared that there is no conflict of interest. Part of this work was supported by a VICI grant from the Dutch Organization for Scientific Research awarded to Prof Dr Johan Denollet.

Do not conclude that improving self-care will improve quality of life. This was an observational study, within-person changes in self-care were not related to quality of life, and depression accounted for nearly all of the association.