Abstract 11085: Testing the Life Context Model of Self-Care and Outcomes in Heart Failure: The Role of Psychosocial and Aging Factors
Most of the cost of heart failure (HF) care is due to hospitalizations, most of which can be traced to failed self-care. Factors leading to poor self-care and affecting relationships among patient characteristics, self-care, and rehospitalization and mortality have not been delineated.
Objective: To determine psychosocial and aging predictors of self-care guided by the Life Context Model of Self-Care (Figure), and whether self-care mediates the relationship of psychosocial and aging factors to outcomes.
Methods: Data from 559 HF patients (41% women; mean age 66±13 yrs) were used to test the model. Established instruments were used to measure model constructs: depression (PHQ-9); anxiety (Brief Symptom Inventory); perceived control (Control Attitudes Scale-R), social support (living alone and marital status); health literacy (Test of Functional Health Literacy); cognitive status (Minicog); symptom status and perceptions (HF Symptom Response Questionnaire); functional status (NYHA class); and comorbidity burden (Charlson Comorbidity Index). Context and life course factors (see model) were included as covariates. Multivariate regression and Cox regression with mediation analyses tested the model.
Results: The self-care model was significant (p < 0.001) and explained 28% of variance in self-care. Independent predictors of poor self-care were depression, perception that symptoms are vague, and low perceived control (p <0.01 for all). Independent predictors of poorer outcome in the Cox regression model (p<0.001) were depression (odds ratio [OR] 1.13), poor health literacy (OR 1.97), higher comorbidity burden (OR 1.2), and poor self-care (OR 2.1). Self-care mediated the association of psychosocial and aging factors to outcomes.
Conclusion: Psychosocial and aging factors are fundamental predictors of self-care, which must be improved to change rehospitalization and mortality outcomes.
- © 2013 by American Heart Association, Inc.