Abstract 904: Biomarkers of Myocardial Stress and Systemic Inflammation are Lower in Patients Who Engage in Heart Failure Self-Care Management
Background: Self-care is believed to improve outcomes; but, proposed mechanisms through which self-care may influence outcomes in the heart failure (HF) population remain untested. The purpose of this study was to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation in adults with HF.
Methods: A secondary analysis was completed of cross-sectional data collected on 168 patients with symptomatic HF (mean 58.8±11.5 years, 65.5% male, LVEF 34.9%±14.0%, 50.6% NYHA III). Hierarchical logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of NTproBNP and soluble TNFα receptor type 1 at or above the sample median, the cut-off value shown by others to be associated with an increased risk of urgent transplantation/assist device implantation and mortality. HF self-care was defined as behaviors that prevent exacerbations (self-care maintenance) and decision-making to quickly recognize and treat symptoms as soon as they occur (self-care management) and was measured using the Self-Care of Heart Failure Index.
Results: Measures of self-care were an independent factor in the model (block χ2=14.74, p=.005) after controlling for age, gender, BMI, Charlson comorbidity category, LVEF, NYHA functional class, HF etiology, and prescribed medications (model χ2=52.15, p<.001). Although self-care maintenance was not a significant determinant, each one-point increase in self-care management score (range 15–100) was associated with a 12.7% reduction in the odds of having both biomarkers at or above the sample median (adjusted odds ratio=0.873, 95% CI=0.77– 0.99, p=.03).
Conclusion: Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacologic therapy and other common confounding factors. Teaching HF patients the skills of early symptom recognition and intervention may decrease myocardial stress and systemic inflammation and thereby improve HF outcomes.