Abstract 12230: Profiles of Heart Failure Self-Care Behavior Predict 6-Month Event-Free Survival
Introduction: Prior studies have identified three major profiles of heart failure (HF) self-care behaviors: novice, inconsistent, and expert. We hypothesized that these HF self-care profiles are associated with differences in 6-month event-free survival.
Methods: A secondary analysis was performed using data from 280 adults with HF participating in a study on the influence of sleep on HF self-care. Self-care was defined as a naturalistic decision-making process involving behaviors that help maintain physiological homeostasis (maintenance) and the response to HF symptoms when they occur (management). HF self-care was measured at baseline using the Self-Care of HF Index (SCHFI). SCHFI scores were standardized to range from 0-100 with higher values indicating better self-care. Latent class mixture modeling was used to identify distinct profiles among SCHFI maintenance and management items. Discrete- and continuous-time survival by self-care profile was quantified using χ2 tests and Cox proportional hazards modeling respectively; the composite endpoint was 6-month all-cause hospitalization or death.
Results: The average age of the sample was 62±12 years, 36% were female, 57% had NYHA class III, and the average LVEF was 35±17%. Four distinct HF self-care profiles were identified (model entropy =91%, posterior probabilities ≥98%). In addition to novice (n=49, 17.4%), inconsistent (n=20, 7.1%), and expert (n=54, 19.1%) self-care profiles, we identified a group that was asymptomatic at baseline (n=159, 56.4%). The prevalence of 6-month all-cause hospitalization or death was 45% for novices, 40% for those who were inconsistent, 54% for experts, and 30% for those who were asymptomatic at baseline (χ2=11.5, P=.009). Controlling for age, gender, and NYHA class, the hazard of events was 1.24 for novices (95%CI=0.89-1.75; P=.21), 1.08 for intermediates (95%CI=0.66-1.76; P=.76), and 1.43 for experts (95%CI=1.04-1.95; P=.03) compared with those who were asymptomatic.
Conclusions: Adults at the greatest risk for hospitalization or death were those who reported expert-level HF self-care. This is likely an indication that better and more consistent engagement in self-care behaviors is driven in part by the progressive nature of HF.
- © 2011 by American Heart Association, Inc.