Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = −0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties.

Background-Dietary vitamin K is thought to be an important factor that interferes with anticoagulation stability, but the clinical applicability of this interaction has not been evaluated adequately in prospective studies. Methods and Results-In a randomized controlled trial that enrolled outpatients with a recent international normalized ratio (INR) outside the therapeutic target, we compared 2 strategies to optimize long-term oral anticoagulation: (1) a conventional approach based on changes in anticoagulant prescription and (2) a dietary vitamin K-guided strategy based on simple modifications of the amount of vitamin K-rich foods ingested per week. The primary efficacy end point was the percentage of patients who achieved a prespecified INR target at 90 days after randomization. Study population (nϭ132) predominantly included men with mechanical heart prostheses (58%) or atrial fibrillation (35%). Over time, patients allocated to the vitamin K-guided strategy reached the prespecified INR more frequently so that after 90 days of follow-up, 74% were on target compared with 58% of patients managed conventionally (Pϭ0.04). Patients allocated to the dietary vitamin K-guided strategy had the same magnitude and direction of INR variation as those observed with the conventional approach in the short term (15 days) for both underanticaogulated and overanticoagulated patients.Minor bleeding or use of parenteral vitamin K were also marginally less frequent in patients managed according to the dietary intervention (1 [1.5%] versus 7 [11%]; Pϭ0.06). Conclusions-A vitamin K-guided management strategy to adjust long-term oral anticoagulation is feasible and safe and may result in an increased chance of reaching target levels of INR.

Objective: To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale. Methods: The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting) and validation (assessment of face validity, content validity, and internal consistency reliability) were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF) and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care).Results: The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbach's Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87. Conclusion: Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.Descriptors: Heart Failure; Self-care, Nursing Education; Validation Studies. Adaptación transcultural y validación de la European Heart Failure Self-care Behavior Scale para el Portugués de Brasil Objetivo: Adaptar y validar European Heart Failure Self-Care Behavior Scale para uso en lengua portuguesa de Brasil. Métodos: El proceso de adaptación cultural (traducción, síntesis, retro traducción, revisión por comité de expertos y pré test), validación (validez de facie, de contenido y confiabilidad) fue realizado según la literatura. La European Heart Failure Self-Care Behavior Scale evalúa los componentes-clave para el auto cuidado: IntroductionRecent studies have emphasized the importance of systematic education on the disease and selfcare for patients with heart failure (1)(2) . The objectives of this process are to teach, strengthen, improve and constantly evaluate the abilities of patients to manage their self-care (1) . Systematic disease education contributes to the prevention of factors that might precipitate decompensation, thus reducing the number of readmissions (2) . However, information and guidance dispensed to patients in settings such as hospitals, heart failure clinics, and their own homes are not always evaluated with regard to the effectiveness of implementation (3) .In the context of heart failure, self-care can be defined as adherence to medication, lifestyle recommendations (diet and physical exercise), and disease management at the earliest signs of decompensation (3) . While several questionnaires are available for assessment of self-care and disease knowledge, there are few studies suggesting brief and practical tools targeted to heart failure patients (3)(4)(5) .In the scope of heart failure, self-care has been a focus of interest for the development of tools that could assess patient behaviors. The first such instrument, originally called the Self-management of Heart Failure Instrument, was developed by United States nurse researchers and was d...