Current status and global trends in self-care among patients with heart failure: challenges and opportunities

Self-care effectively improves outcomes in adults with chronic conditions such as heart failure (HF). Yet engaging patients in self-care maintenance, self-care monitoring, and self-care management has proven to be difficult for patients and providers. In this review we define self-care as a decision-making process involving the choice of behaviors that maintain physiologic stability and the response to symptoms when they occur. The three core self-care behaviors of maintenance, monitoring, and management are defined and situated within their theoretical context. Available approaches to measurement are described. Details of what is known about self-care maintenance, self-care monitoring, and self-care management from the global literature are synthesized, focusing on efforts to promote HF self-care behaviors and illustrating the challenges experienced by patients. Barriers to and facilitators of HF self-care are described. Hypothesized and known links between HF self-care and pathophysiology such as myocardial stretch, systemic inflammation, neurohormonal activation, and renal function are reviewed. Guidance is provided on how to design effective self-care interventions. Opportunities for future research are described. The article ends with comments on implications for policy to position self-care as a pillar of universal health coverage.