Insufficient Self-Care Is an Independent Risk Factor for Adverse Clinical Outcomes in Japanese Patients With Heart Failure

Abstract

SummarySelf-care is a cornerstone for the successful management of heart failure (HF). The purpose of this study was to examine the impacts of HF self-care on prognosis in Japanese patients with HF. A total of 283 HF outpatients (age 64 ± 14, 70% male, 52% HFrEF) were enrolled. We asked patients to answer about their adhevence to 5 self-care behaviors (medication, eating a low-sodium diet, regular exercise, daily weight check, and treatment seeking behavior). On the basis of the results, we classifi ed patients into a good self-care group and a poor self-care group. The primary outcome was HF hospitalization and/or cardiac death. In total, 65% of patients were classifi ed into the poor self-care group. During a median follow-up of 2 years, cardiac events occurred more frequently in the poor self-care group (22% versus 9.6%, P = 0.013). Poor self-care was an independent risk factor for cardiac events in Cox regression analysis adjusted for clinical parameters (hazard ratio = 2.86, P = 0.005). Poor self-care was also associated with an increased number of HF hospitalizations as well as an extended length of hospital stay for HF. Poor knowledge about HF was an independent determinant for poor self-care in multivariate logistic regression analysis (odds ratio = 0.92, P = 0.019). Insuffi cient self-care is an independent risk factor for cardiac events in Japanese patients with HF. (Int Heart J 2013; 54: 382-389) Key words: Compliance, Mortality, Morbidity, Patient education M ortality from coronary heart disease has been consistently declining over the past several decades. In concert with this decline and aging of the population, the number of patients who are at risk for heart failure (HF) is increasing to the point where now there are > 1.2 million ambulatory care patients in Japan.1) The course of HF is marked by frequent exacerbations that result in hospitalization, which are costly and contribute to poor quality of life for patients with HF.2) There are multiple modifi able factors known to precipitate hospitalization for HF exacerbation, which includes non-adherence to medications, diet, and failure to seek timely medical care for escalating symptoms.3) For this reason, approximately half of admissions are considered to be potentially preventable with adequate self-care. 3,4) Effective self-care is an essential and adjunctive strategy to evidence-based medical treatment in delaying the progression of HF. Data from a meta-analysis have demonstrated that HF disease management programs aimed at promoting selfcare reduced rehospitalization rates and mortality. 5) HF patients require self-care behaviors to maintain their physiological stability (self-care maintenance) and to respond to symptoms when they occur (self-care management).6) HF self-care maintenance behavior includes taking medications, eating a low-sodium diet, routine exercise, and symptom monitoring. 6)With respect to the relationship between such HF selfcare behaviors and subsequent clinical outcomes, several studies have shown that poor adherence...

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