Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes

Abstract

Aim To evaluate the abilities to perform essential tasks for heart failure (HF) self‐management in elderly patients, and its influence on post‐discharge prognosis. Methods and results Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self‐administered questionnaire European HF Self‐care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self‐care on 1‐year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1 years. On average, patients could perform 2.9 ± 1.6 of self‐care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self‐care education had slight better performance (3.2 ± 1.6 vs 2.8 ± 1.6, P < 0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r = −0.135; P = 0.006). One‐year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P = 0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32–1.03; and HR 0.40; 95% CI 0.21–0.77, respectively], without differences in readmissions. Conclusion Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self‐care. Self‐perception of care was poorly correlated with real ability, and poor self‐care ability was associated with higher 1‐year mortality risk.

We told you so: ‘knowledge is not enough to improve heart failure self‐care behaviour’

“…Thirdly, Vidan and co‐workers confirm earlier studies that a large proportion of elderly patients with heart failure are unable to perform independently the most essential tasks for heart failure self‐care and this is associated with an increased mortality . Support is needed from either informal or formal caregivers .…”

“…In summary, this study by Vidan et al . clearly underlines that many patients with heart failure struggle with all the important aspects of heart failure self‐care.…”

“…In an innovative and elegantly conducted study in this issue of the Journal, Vidan and colleagues report data that confirm what many clinicians caring for elderly heart failure patients have sensed and suspected, namely, that even if persons report that they perform self‐care behaviours it may not always happen in reality. In the study of Vidan et al ., patients could on average perform three of six important self‐care tasks: (i) to stand on a scale to take a reliable weight, (ii) to read and write down the weight, (iii) to assess oedemas, (iv) to identify the prescribed diuretic from a pill box, (v) to adjust the prescribed dose of diuretic treatment based on weight changes, and (vi) to identify highly salted foods.…”

“…We fully agree with Vidan and colleagues who state that ‘as global self‐care ability is independently associated with outcomes and potentially subject to changes, we should adjust the way of assessing these and educating elderly patients for heart failure self‐management.’…”

November 2019 at a glance. Chronic and acute heart failure: from epidemiology to treatment

“…Self‐perception of care, detected by specific questionnaires, was poorly correlated with real ability. Poor self‐care ability was associated with an increased risk of 1‐year mortality …”