In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.

Differences in how HF patients and caregivers appraise symptoms together must be taken into consideration when examining contributions to HF care and caregiver outcomes.

Background Both heart failure (HF) symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time. Aims Determine whether patterns of physical symptoms are significantly associated with HF self-care over time. Method Latent mixture analysis was used to identify sub-groups based on physical symptoms of dyspnea, sleepiness and edema (using the HF Somatic Perception and Epworth Sleepiness Scales). Growth modeling was used to determine if symptom sub-groups were associated with self-care behaviors (using the Self-care in HF Index) over 6 months. Socio-demographic and clinical variables predicting likelihood of sub-group membership were identified using logistic regression. Results The sample (n=146) was on average 57 years old, 70% were men and 59% had class III/IV HF. Two symptom sub-groups were identified (entropy=0.91); a high symptom group (n=24(16%)) with no significant change in symptoms over time (high sustained), and low symptom group (n=122(84%)) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (OR=3.67, p=0.023) and patients with more depressive symptoms (OR=1.16, p=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin-angiotensin-aldosterone system agent were less likely to be in the high symptom group (OR=0.17, p=0.015). Conclusion Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. Results of this study support symptoms as an important driver of self-care behaviors.

Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple.

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