Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study

Eur J Cardiovasc Nurs. 2013 Apr;12(2):167-76. doi: 10.1177/1474515112439964. Epub 2012 Apr 18.


Background: Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component.

Aims: The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF.

Methods: In a cross-sectional study of 318 patients with chronic systolic HF recruited in 48 German primary care practices, we evaluated the patient-reported European HF Self-care Behaviour scale (EHFScBs) assessments (range 12-60, where lower scores indicate better self-care). Potential determinants included socio-demographic (e.g. age, living status), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, co-morbidities), behavioural (e.g. smoking and alcohol intake), psychosocial (SF-36 scales and KCCQ domains, e.g. quality of life and self-efficacy) and depression status (PHQ-D), plus previous health care utilisation. Mixed regression modelling was applied.

Results: Patients had a mean (SD) age of 69.0 (10.4) years and were 71% male. They had a good overall EHFScBs score of 24.7 (7.8) (n=274). In the final regression model (n=271), six determinants were retained (β; descriptive p-value): self-efficacy (-0.24; <.001), age (-0.22; <.001), prosthetic heart valve (-0.14; .01), referrals to cardiologists (-0.14; .02), peripheral arterial disease (0.13; .03) and quality of life (0.16; .02).

Conclusion: In this exploratory cross-sectional study, the potential non-modifiable and modifiable risk factors and resources involved in patients' HF self-care were at the individual and organisational level. Self-efficacy and quality of life are potentially modifiable, so these could be targeted for improvement by enhancing patient motivation, HF education and further supporting a collaborative care approach.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care
  • Cross-Sectional Studies
  • Female
  • Health Behavior*
  • Health Status
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Quality of Life
  • Self Care*
  • Socioeconomic Factors