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Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure
Dionne Kessing1, Johan Denollet1, Jos Widdershoven2
1Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.
Insights
Global self-care did not impact mortality in heart failure (HF) patients. However, low sodium intake was linked to higher death risk, suggesting a need for further research into dietary impacts on HF prognosis.
Area of Science:
- Cardiology
- Public Health
- Behavioral Science
Background:
- Self-care is vital for managing chronic heart failure (HF).
- Limited research exists on the link between self-care behaviors and clinical outcomes in HF patients.
- Understanding factors influencing mortality is crucial for improving HF patient management.
Purpose of the Study:
- To investigate the association between self-care behaviors and all-cause mortality in a cohort of chronic heart failure (HF) patients.
- To identify specific self-care aspects that may influence long-term survival in HF.
- To explore potential predictors of mortality in this patient population.
Main Methods:
- A cohort of 559 chronic HF patients completed the European Heart Failure Self-care Behaviour scale.
- All-cause mortality was the primary endpoint, assessed over a median follow-up of 5.5 years.
- Kaplan-Meier and multivariable Cox regression analyses were used, controlling for clinical and demographic factors.
Main Results:
- No significant association was found between global self-care and all-cause mortality (p = 0.71).
- Low self-reported sodium intake was independently associated with increased mortality (aHR: 1.47; 95% CI: 1.10-1.96; p = 0.01).
- Male sex, lack of a partner, advanced NYHA class (III-IV), and comorbidities also predicted mortality.
Conclusions:
- Global self-care behaviors were not linked to long-term mortality in chronic HF patients.
- Low sodium intake emerged as an independent predictor of increased all-cause mortality, independent of disease severity.
- Further research is recommended to validate these findings and explore subjective versus objective sodium intake measurements in HF prognosis.
Objectives:
This study examined the association of self-care with all-cause mortality in a cohort of patients with chronic heart failure (HF).
Background:
Although self-care is crucial to maintain health in patients with chronic HF, studies examining an association with clinical outcomes are scarce.
Methods:
Consecutive patients with chronic HF (n = 559, mean age 66.3 ± 9.5 years, 78% men) completed the 9-item European Heart Failure Self-care Behaviour scale. Our endpoint was all-cause mortality. Associations between self-care and all-cause mortality were assessed with Kaplan-Meier analyses and multivariable Cox regression accounting for standard sociodemographic and clinical covariates, psychological distress, and self-rated health.
Results:
After a median follow-up of 5.5 ± 2.4 years (range 16 weeks to 9.9 years), 221 deaths (40%) from any cause were recorded. There was no evidence of a mortality benefit in patients high over those low in global self-care (p = 0.71). In post hoc analyses, low self-reported sodium intake was associated with increased mortality (adjusted hazard ratio: 1.47; 95% confidence interval: 1.10 to 1.96; p = 0.01). Other significant predictors of mortality were: male sex, lack of a partner, New York Heart Association functional class III to IV, and increasing comorbid conditions.
Conclusions:
Global self-care was not associated with long-term mortality whereas low self-reported sodium intake independently predicted increased all-cause mortality beyond parameters of disease severity. Replication of findings is needed as well as studies examining the correspondence of subjectively and objectively measured sodium intake and its effects on long-term prognosis in patients with chronic HF.
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