Pancani Luca, Ausili Davide, Greco Andrea, Vellone Ercole, Riegel Barbara
Department of Psychology, Università degli Studi di Milano - Bicocca, Milan, Italy.
Department of Medicine and Surgery, Università degli Studi di Milano - Bicocca, Monza, Italy.
Int J Behav Med. 2018 Aug;25(4):399-409. doi: 10.1007/s12529-018-9731-2.
Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients' characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories.
We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association.
Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated.
Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.
心力衰竭（HF）影响着高达14%的老年人口，且其患病率正在上升。自我护理是成功应对该综合征的基础，但对于自我护理如何随时间演变却知之甚少。本研究旨在：（a）确定HF患者自我护理信心和维持的纵向轨迹；（b）调查每条轨迹是否具有特定的社会人口统计学和临床患者特征；（c）评估自我护理信心和维持轨迹之间的关联。
我们对225名HF患者进行了一项前瞻性描述性研究，随访6个月，在基线、3个月和6个月时收集数据。采用潜在类别增长分析（LCGA）来确定纵向轨迹。使用方差分析和列联表来描述轨迹并调查它们之间的关联。
确定了三条自我护理信心轨迹（持续较差、逐渐充分和逐渐最佳）和三条自我护理维持轨迹（持续较差、临界但改善和逐渐良好）。已婚个体处于自我护理信心持续较差轨迹的可能性较小。自我护理维持持续较差的患者服用的药物比自我护理维持较好轨迹之一的患者少。这两组轨迹之间存在显著且有意义的关联。
处于自我护理较差轨迹（信心或维持）的患者有很高的风险长期处于该状态而无改善。这些结果可用于制定针对性更强且可能更有效的医疗保健干预措施。
