The relationship between self-care, long-term mortality, and heart failure hospitalization: insights from a real-world cohort study

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2022-03, Vol.21 (2), p.116-126
• Main Authors: Calero-Molina, Esther, Hidalgo, Encarna, Rosenfeld, Laia, Verdú-Rotellar, Jose Maria, Verdú-Soriano, Jose, Garay, Alberto, Alcoberro, Lidia, Jimenez-Marrero, Santiago, Garcimartin, Paloma, Yun, Sergi, Guerrero, Carmen, Moliner, Pedro, Delso, Cristina, Alcober, Laia, Enjuanes, Cristina, Comin-Colet, Josep
• Format: Article
• Language: English
• Subjects: Cohort Studies; Heart Failure - therapy; Hospitalization; Humans; Long-Term Care; Prospective Studies; Self Care
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1093/eurjcn/zvab011

The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988-0.997), P-value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981-0.996), P-value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988-0.998), P-value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991-0.999), P-value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201-2.127), P-value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114-1.923), P-value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140-1.923), P-value = 0.006] were all associated with higher risk of all-cause mortality. In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.