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Trends and influencing factors of self-management in patients with chronic heart failure: a longitudinal study
Wen Ding1, Jingyu Lu2, Fei Wang3
1General Hospital of Ningxia Medical University, 804 Shengli Street, Xingqing District, Yinchuan, China. Dwnxykdxzyy@126.com.
Insights
Patient self-management in chronic heart failure (CHF) improves outcomes but declines after 3 months post-discharge. Interventions should consider this dynamic trend and influencing factors like social support and self-efficacy.
Area of Science:
- Cardiology
- Health Services Research
- Behavioral Medicine
Background:
- Effective self-management behaviors are crucial for patients with chronic heart failure (CHF), improving quality of life and reducing healthcare utilization.
- Existing research on CHF self-management in China is limited, particularly longitudinal studies tracking changes beyond six months post-discharge.
- Understanding the trajectory and influencing factors of self-management is vital for timely and targeted interventions.
Purpose of the Study:
- To investigate the changes in self-management levels among CHF patients within one year after hospital discharge.
- To identify key factors influencing self-management behaviors in this population.
- To provide evidence for optimizing the timing and content of self-management interventions.
Main Methods:
- A longitudinal study design was employed from December 2021 to June 2022.
- Data were collected from patients with CHF at baseline (T0) and at 1, 3, 6, and 12 months post-discharge (T1-T4).
- Variables included demographics, disease characteristics, social support, and self-efficacy.
Main Results:
- Self-management scores were lowest at baseline, peaked at 1 month post-discharge, and declined from 3 months onwards, stabilizing by 6 months but remaining above baseline.
- Factors influencing self-management included social support, self-efficacy, disease duration, medication type, education level, and income.
- A significant number of patients (213 enrolled, 173 completed 12-month follow-up) provided robust data for analysis.
Conclusions:
- Self-management in CHF patients is a dynamic process, with levels peaking early post-discharge and then trending downwards.
- Interventions should be timed strategically, considering the observed decline after the initial 3-month period.
- Multiple factors interact to influence patient self-management, necessitating a multifactorial approach to interventions.
Background:
Good self-management behaviors can improve the physical function and quality of life of patients with heart failure and reduce hospitalization, mortality, and medical expenses. While the overall self-management level among patients with chronic heart failure (CHF) in China is low, previous studies have often used a cross-sectional design, and few have followed up on patients' self-management beyond 6 months after discharge. This study aimed to explore the factors influencing and the changes in the self-management level of patients with CHF and provide a basis for the timing and choice of interventions within 1 year after discharge.
Methods:
A longitudinal study was conducted from December 2021 to June 2022, including patients with CHF who met all the inclusion criteria. Data on demographics, disease-related details, social support, self-efficacy, and other information were collected during hospitalization (T0) and reevaluated at 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4) after discharge.
Results:
A total of 213 patients were enrolled at T0, with 206, 201, 189, and 173 patients completing follow-up at T1, T2, T3, and T4, respectively. The self-management score was lowest at T0, highest at T1, began to decline at T2, and stabilized at T3; however, T3 remained higher than T0. Social support, self-efficacy, disease course, medication type, education level, and personal monthly income were identified as factors influencing self-management.
Conclusions:
The study findings indicate that self-management is a dynamic process of change. The level of self-management was at a high level 3 months after the patients were discharged from the hospital, but showed a decreasing trend from 6 months, which was related to numerous factors. This study helps to provide a theoretical basis for the timing and content of self-management intervention for patients with CHF by clinical healthcare professionals.
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