Proper self-care leads to better outcomes in HF, but underappreciated

Barbara Riegel

NEW ORLEANS — Self-care plays an important role in outcomes of patients with HF, but is not emphasized by clinicians as much as it should be, a speaker said at the American College of Cardiology Scientific Session.

“Ninety-nine percent of care for chronic illnesses is performed by patients and families, not health care providers,” Barbara J. Riegel, PhD, RN, FAAN, Edith Clemmer Steinbright Professor of Gerontology and facilitator of the Biobehavioral Research Collaborative at the University of Pennsylvania School of Nursing, said during a presentation.

These activities include:

self-care maintenance, which includes diet, exercise, medication adherence, avoiding tobacco, managing stress and getting proper sleep;

self-care monitoring, which includes body recognition, recognition of signs and symptoms, and proper interpretation of symptoms; and

self-care management, which includes changing behavior in accordance with signs and symptoms, and alerting health care providers when necessary.

According to Riegel, a study she conducted with colleagues found that even a minimal amount of self-care reduces myocardial stress and systemic inflammation, whereas an average amount decreases risk for clinical events, and the best self-care will make a patient with HF appear as healthy as anyone from the general public.

However, she said, there are many barriers to patients with HF performing self-care.

“Self-care declines as levels of comorbidity rise, probably because self-efficacy declines,” Riegel said. “A lot of patients don’t take their medications because they don’t want to, often because they have so many of them. And fragmented self-care instruction leads to poor integration of self-care and self-care defects.”

Patients with HF average 10 medications, and 75% of older adults with multiple chronic conditions are at risk for therapeutic competition, defined as taking at least one medication that helps with one condition but harms another, according to Riegel.

Further complicating matters is that expectations for self-care are high, but there may not be much help available outside the clinical setting, she said.

Poor symptom interpretation is another problem.

“For example, shortness of breath, which is a classic symptom of heart failure, was recognized by 93% of patients in one study, but only 59% correctly interpreted that it was related to their heart failure,” she said.

“Patient education is necessary but not sufficient to improve self-care and avoid hospitalization,” Riegel said. “We have to recognize that we contribute to poor self-care through fragmented instructions and polypharmacy. Consider de-prescribing certain medications, especially in the very elderly, ask patients how quickly they recognize their symptoms and what they do to manage them, assess patterns of symptoms to identify potential problems and promote self-care early. Patients with heart failure get better at recognizing their symptoms as their condition gets worse, by which point there is less we can do for them. We are missing the window of opportunity, which is in the early stages of heart failure.” – by Erik Swain

Reference:

Riegel BJ. Session 602: The right quality and performance metrics and the right outcomes in heart failure. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Disclosure: Riegel reports no relevant financial disclosures.