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Effective self-care for patients with HF influenced by many factors
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A new scientific statement from the American Heart Association delineates the concepts and available evidence necessary for the application of effective self-care in patients with HF.
The statement summarizes relevant clinical data and other information on what is currently known about the behaviors required for effective self-care in patients with HF, factors that make self-care more difficult for patients, interventions that promote self-care and potential effects of self-care on HF outcomes. Specific self-care behaviors such as medication adherence and the self-monitoring of symptoms are cited as imperative for effective self-care, as were lifestyle adjustments such as dietary adherence, exercise, weight loss, alcohol and fluid restriction and smoking cessation.
Some of the factors making self-care more challenging include comorbid conditions that frequently accompany HF such as hypertension and CAD. In addition, anxiety and depression are cited as common occurrences in HF patients, which complicate physical and mental health status. Age-related issues (particularly in older patients), such as impaired cognition and sleep disturbances, also present challenges to effective self-care in patients with HF. Systemic problems with the health care system, including a general lack of education and promotion of effective self-care behaviors and principles, as well as a lack of health literacy, also represent obstacles for effective self-care when living with HF. Interventions that promote self-care include skill development and behavioral intervention with counseling, as well as relying on social support from family members and friends.
Data on the effects of self-care on HF outcomes is sparse, due primarily to the reciprocity of relationships between HF self-care and health outcomes or to temporal assignment, according to the statement. Results from the few studies attempting to measure the effects of self-care on outcomes suggested implied benefits from self-care on hospital readmission. Apart from evidence of an advantageous effect on a composite of mortality and all-cause hospitalization, self-care has not been conclusively shown to have a measurable effect on mortality alone or even quality of life in patients with HF. Results from one cited study suggested that patients with HF who were more engaged in self-care had lower direct HF inpatient costs.
“Sorting out the appropriate approach to improving self-care is essential for future research,” the authors wrote in the statement. “The efficacy of family-focused behavioral and psychosocial interventions in other chronically ill populations suggests that these might be useful for HF patients in improving self-care, yet more remains to be learned about the most advantageous approaches and doses and the influence of patient gender and age on intervention outcomes.” – by Eric Raible
Riegel B. Circulation. 2009;doi:10.1161/CIRCULATIONAHA.109.192628.
This scientific statement is a valuable tool in the treatment of people with HF. The concepts developed here of educating and empowering people to manage their disease are the mainstay of successful HF programs worldwide. More importantly, the authors examine the comorbid problems that hamper this self-care, such as depression. This type of an approach to HF management will have a major impact on patients and could go further to reduce hospitalization and subsequent rehospitalization than any of the current metrics being tracked by regulatory agencies and payers. This advance to a self-care directed treatment approach for HF should be the backbone of every concerted HF effort now and in the future.
– Frank Smart, MD
Cardiology Today Editorial Board member