Abstract 3899: Self-care Confidence Moderates Quality of Life in Heart Failure Patients With Implantable Cardioverter-Defibrillator
Background: Longer exposure to chronic illness from the survival benefit of an implantable cardioverter-defibrillator (ICD) may further challenge heart failure (HF) patients with ICDs to follow intricate self-care regimens and obtain quality of life (QOL). It remains unknown whether ICD implantation increases the complexity of self-care in HF.
examine self-care of HF patients with or without ICDs; and
determine whether self-care confidence had a moderator effect between ICD therapy and QOL outcomes.
Methods: In a sample of 269 HF patients (mean age 61±11.70, 33% female, 70% Caucasian, 77% NYHA class II/III) using a cross-sectional design, we examined self-care maintenance, management, and confidence (subscales of the Self-Care of Heart Failure Index) of HF patients with (n=132) or without (n=127) ICDs using general linear models, controlling for sex. To determine the moderator effect of self-care confidence on QOL (SF-36 physical and mental health), a series of general linear models with/without an interaction term (self-care confidence × ICD therapy) were performed, controlling for age, sex, ejection fraction, comorbidity, and inflammatory biomarkers (TNF-α, Interleukin-6).
Results: The ICD therapy was associated with greater self-care in maintenance (β [SE] = 5.19[2.15]; p=.017) and confidence (β [SE] = 4.49[2.25]; p=.047). No statistically significant difference in management between the groups was observed. The moderating effect of self-care confidence on QOL outcomes was found. The interaction term (self-care confidence × ICD therapy) was a significant predictor of SF-36 mental health (β [SE] = 0.23[0.11], p=0.0368), accounting for 25% (F=4.08, p<.001) of the variance.
Conclusion: This is one of the first studies to examine self-care specifically in HF patients with ICDs. In a large multisite study with moderately symptomatic HF patients, ICD therapy was not likely to reduce self-care. On the contrary, patients with ICDs reported higher self-care maintenance. The patients with ICDs had greater mental health when self-care confidence was high. This finding provides evidence of the moderating effect of self-care confidence and support for intervention targeting at self-care confidence in HF patients with ICDs.