Abstract 3091: Self-Care Improves Health-Related Quality of Life in Hispanics with Heart Failure
Health-related quality of life (HRQL) is poor in persons with heart failure (HF). Many interventions that effectively improve hospitalization rates are surprisingly ineffective in improving HRQL. We hypothesized that HRQL improves in patients who engage in self-care but not in those who do not become active in caring for their illness. Self-care was defined as a naturalistic decision-making process encompassing treatment adherence (self-care maintenance) and decision-making about symptoms (self-care management).
Methods: Data from 134 Hispanics with chronic HF enrolled in a clinical trial of telephone disease management emphasizing self-care were analyzed in this secondary analysis. The sample, enrolled during hospitalization and randomized to intervention (n=69) or usual care (n=65), was elderly (72 11 years), NYHA class III/IV (81.3%), poorly educated (78.4% <high school), and poor (81% annual family income <$15,000). Most (55%) were entirely unacculturated into U.S. society. Self-care was measured using the maintenance and management subscales of the Self-Care of HF Index (SCHFI). The Minnesota Living with HF questionnaire total score was used to measure HRQL. Complete enrollment and 3-month data were available on 107 of the 134 in the sample (80%). Patients were categorized as having improved in self-care from baseline to 3-months if:
both maintenance and management subscale scores improved 8 points; or
maintenance score improved 8 points and the patient was asymptomatic at follow-up. ANOVA was used to test for differences in HRQL at 3-months after adjusting for baseline HRQL score.
Results: By 3-months, 69% (n=74) had improved in HF self-care. Self-care improved in both groups but those in the intervention group were more likely to improve (78.2%) than those in the usual care group (59.6%) (p=.03). HRQL was significantly better in those who improved in self-care compared to those who did not improve in self-care (12.7 13.9 vs. 18.9 16.2 [lower scores = better HRQL]; F=6.6, df=2,104, p=.01).
Conclusion: Engagement in self-care may explain why some disease management interventions improve HRQL and others do not. Interventions that emphasize promoting self-care may be more effective than those involving passive monitoring of patients.