Heart failure beliefs and self-care adherence while being treated in an emergency department

J Emerg Med. 2014 Jan;46(1):122-9. doi: 10.1016/j.jemermed.2013.04.060. Epub 2013 Sep 17.


Background: Heart failure (HF) emergency department (ED) visits are commonly due to HF self-care nonadherence.

Objective: Our objective was to assess the accuracy of HF beliefs and adherence to self care in patients using an ED for acute HF.

Methods: A cross-sectional, correlational study using validated surveys of HF beliefs and self-care adherence was conducted. A multivariable regression model was used to control for significant baseline factors.

Results: In 195 adults, mean HF beliefs score was 2.8 ± 0.3, significantly below the accurate cutoff score of 3.0 (p < 0.001). Mean HF self-care adherence score was 5.1 (10 reflects best adherence). Of HF-related self-care behaviors, adherence was highest for taking medications without skipping or missing doses (7.8 ± 3.3) and lowest for daily weight monitoring (3.5 ± 3.5). Higher accuracy in HF beliefs was associated with higher education level (p = 0.01), younger age (p < 0.001), and choosing low-sodium restaurant foods (p = 0.04), but not with adherence to other self-care behaviors. Self-care adherence was associated with the belief that the HF care plan must be followed forever (p = 0.04), but not with other HF beliefs; and there was a trend toward lower HF self-care adherence when HF belief scores were more accurate. After controlling for significant baseline factors, HF beliefs were not associated with self-care adherence (p = 0.15).

Conclusions: Patients seeking ED care for decompensated HF had inaccurate HF beliefs and poor self-care adherence. Lack of association between HF beliefs and self care (and trend of an inverse relationship) reflects a need for predischarge HF education, including an explanation of what HF means and how it can be better controlled through self-care behaviors.

Keywords: adherence; emergency care; heart failure beliefs; self care; sodium in restaurant foods.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Weight
  • Cross-Sectional Studies
  • Educational Status
  • Emergency Service, Hospital
  • Exercise
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Heart Failure / therapy*
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Self Care*
  • Sodium, Dietary


  • Sodium, Dietary