Lee Christopher S, Bidwell Julie T, Paturzo Marco, Alvaro Rosaria, Cocchieri Antonello, Jaarsma Tiny, Strömberg Anna, Riegel Barbara, Vellone Ercole
School of Nursing, Oregon Health & Science University, Portland, OR, USA.
Emory University Nell Hodgson Woodruff, School of Nursing, Atlanta, GA, USA.
Heart Lung. 2018 Jan-Feb;47(1):40-46. doi: 10.1016/j.hrtlng.2017.09.004. Epub 2017 Oct 18.
Heart failure (HF) self-care is important in reducing clinical events (all-cause mortality, emergency room visits and hospitalizations). HF self-care behaviors are multidimensional and include maintenance (i.e. daily adherence behaviors), management (i.e. symptom response behaviors) and consulting behaviors (i.e. contacting a provider when appropriate). Across these dimensions, patterns of successful patient engagement in self-care have been observed (e.g. successful in one dimension but not in others), but no previous studies have linked patterns of HF self-care to clinical events.
To identify patterns of self-care behaviors in HF patients and their association with clinical events.
This was a prospective, non-experimental, cohort study. Community-dwelling HF patients (n = 459) were enrolled across Italy, and clinical events were collected one year after enrollment. We measured dimensions of self-care behavior with the Self-Care of HF Index (maintenance, management, and confidence) and the European HF Self-care Behavior Scale (consulting behaviors). We used latent class mixture modeling to identify patterns of HF self-care across dimensions, and Cox proportional hazards modeling to quantify event-free survival over 12 months of follow-up.
Patients (mean age 71.8 ± 12.1 years) were mostly males (54.9%). Three patterns of self-care behavior were identified; we labeled each by their most prominent dimensional characteristic: poor symptom response, good symptom response, and maintenance-focused behaviors. Patients with good symptom response behaviors had fewer clinical events compared with those who had poor symptom response behaviors (adjusted hazard ratio = 0.66 [0.46-0.96], p = 0.03). Patients with poor symptom response behaviors had the most frequent clinical events. Patients with poor symptom response and those with maintenance-focused behaviors had a similar frequency of clinical events.
Self-care is significantly associated with clinical events. Routine assessment, mitigation of barriers, and interventions targeting self-care are needed to reduce clinical events in HF patients.
心力衰竭（HF）自我护理对于减少临床事件（全因死亡率、急诊就诊和住院）至关重要。HF自我护理行为具有多维度性，包括维持（即日常依从行为）、管理（即症状应对行为）和咨询行为（即在适当的时候联系医护人员）。在这些维度中，已观察到患者成功参与自我护理的模式（例如，在一个维度上成功但在其他维度上不成功），但此前尚无研究将HF自我护理模式与临床事件联系起来。
确定HF患者的自我护理行为模式及其与临床事件的关联。
这是一项前瞻性、非实验性队列研究。在意大利各地招募了社区居住的HF患者（n = 459），并在入组一年后收集临床事件。我们使用心力衰竭自我护理指数（维持、管理和信心）和欧洲HF自我护理行为量表（咨询行为）来测量自我护理行为的维度。我们使用潜在类别混合模型来确定跨维度的HF自我护理模式，并使用Cox比例风险模型来量化12个月随访期间的无事件生存期。
患者（平均年龄71.8±12.1岁）大多为男性（54.9%）。确定了三种自我护理行为模式；我们根据其最突出的维度特征对每种模式进行了标记：症状应对差、症状应对良好和以维持为重点的行为。与症状应对差的患者相比，症状应对良好的患者临床事件较少（调整后风险比 = 0.66 [0.46 - 0.96]，p = 0.03）。症状应对差的患者临床事件最频繁。症状应对差的患者和以维持为重点的患者临床事件发生频率相似。
自我护理与临床事件显著相关。需要进行常规评估、消除障碍以及针对自我护理的干预措施，以减少HF患者的临床事件。
