Determinants of Heart Failure Self‐Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis

Abstract

Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self- management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how HF dyads manage the patient’s care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (i.e., daily adherence and symptom monitoring) and management (i.e., appropriate recognition & response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients were 76.2 (SD=10.7) years, a slight majority (56.9%) was male, while caregivers were 57.4 (SD=14.6) years, and fewer than half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Several significant individual and dyadic determinants of self-care maintenance and self-care management were identified, including gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and maximize outcomes.

Caregivers’ Heart Failure Knowledge Is Necessary but Not Sufficient to Ensure Engagement With Patients in Self-care Maintenance

“…As in an earlier study, 25 relationship quality was significantly related to dyads’ self-care. In that earlier study, however, relationship quality was measured by a 1-item question asking the person to judge how good their relationship was.…”

“…This one item was linked to self-care maintenance and self-care management. 25 What our study suggests is that that self-care self-efficacy may be moderating the relationship between relationship quality and HF self-care, at least for the caregiver. The impact of the caregiver’s perception of the relationship on self-efficacy is supported in the literature.…”

Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

“…One study identified poor caregiver health and higher strain as associated with patients having higher confidence in providing themselves self-care [86]. Similarly though in the opposite direction, in an Italian sample of 364 dyads, increased caregiver physical QoL was associated with lower levels of patient self-care management for male patients [37]; male patients who had healthier caregivers were less likely to personally attend to their self-care needs. The authors postulated that poorer self-care behaviors among male patients may be a function of poor symptom recognition.…”

Caregiver determinants of patient clinical event risk in heart failure

“…From recent observational and interventional research, we know that caregivers play a major role in HF self-care, 31 that the patient-caregiver relationship influences self-care engagement, 32, 45, 46 and that dyadic interventions to improve self-care may be more efficacious than individual approaches. 47, 48 Thus, it is not surprising that caregiver self-care contributions significantly predicted patient event-free survival in this analysis.…”