Event-free survival in adults with heart failure who engage in self-care management

Abstract

Background: Self-care management in heart failure (HF) involves decision-making to evaluate, and actions to ameliorate symptoms when they occur. This study sought to compare the risks of all-cause mortality, hospitalization, or emergency-room admission among HF patients who practice above-average self-care management, those who practice below-average self-care management, and those who are symptom-free.

Methods: A secondary analysis was conducted of data collected on 195 HF patients. A Cox proportional hazards model was used to examine the association between self-care management and event risk.

Results: The sample consisted of older (mean ± standard deviation=61.3 ± 11 years), predominantly male (64.6%) adults, with an ejection fraction of 34.7% ± 15.3%; 60.1% fell within New York Heart Association class III or IV HF. During an average follow-up of 364 ± 288 days, 4 deaths, 82 hospitalizations, and 5 emergency-room visits occurred as first events. Controlling for 15 common confounders, those who engaged in above-average self-care management (hazard ratio, .44; 95% confidence interval, .22 to .88; P < .05) and those who were symptom-free (hazard ratio, 0.48; 95% confidence interval, .24 to .97; P < .05) ran a lower risk of an event during follow-up than those engaged in below-average self-care management.

Conclusion: Symptomatic HF patients who practice above-average self-care management have an event-free survival benefit similar to that of symptom-free HF patients.

Figure 1. Event-Free Survival: Cox Proportional Hazard Model

Cox proportional hazards model results show the difference in composite event-risk for patients who were symptom-free, those who practiced above average self-care management, and those who practiced below average self-care management. Results shown controlling for age, gender, body mass index, Beck Depression Inventory II score, comorbid conditions, left ventricular ejection fraction, heart failure etiology, New York Heart Association functional class, prescription of ACE inhibitors or ARBs, and/or β-adrenergic blockers, Duke Activity Status Index total score, Minnesota Living with Heart Failure Questionnaire total score, Medical Outcomes Study specific adherence score, and Self-Care of Heart Failure Index maintenance and confidence subscale scores. Abbreviations: ACE = angiotensin converting enzyme, ARB = angiotensin receptor antagonist, ER = emergency room, HR = adjusted hazard ratio.