Patient Self-Management In Chronic Heart Failure — Establishing Concordance Between Guidelines And Practice

Abstract

The gold-standard of patient self-management in chronic heart failure (CHF) can be defined as "daily activities that maintain clinical stability". 1 This requires that patients monitor their symptoms, adhere to their medication, diet and exercise regimens and manage symptoms by recognising changes and responding by either adapting behaviours or by seeking appropriate assistance.2 Patient self-management is linked to reduced mortality risk and fewer hospital admissions; however, there is less certainty with regard to the benefits of some aspects of self-care, such as lifestyle choices and fluid restriction.2 According to the European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure, 3 self-management is integral to achieving best patient outcomes: to reduce mortality and improve quality of life.Self-management in CHF usually involves behavioural adaptation.Patients may need to learn new behaviours, such as learning how to monitor and manage symptoms and complex medical regimens.Patients may also need to abstain (e.g. cease smoking), adapt (e.g. AbstractChronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, selfmanagement interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.

Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis

“…Based on the guidelines reported by the European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure [ 9 ], adherence to self-care is an important component of improving patient outcomes—reducing mortality and improving the quality of life. Therefore, guidelines on heart failure management place a strong emphasis on adherence to self-care behaviors such as lifestyle modifications and fluid restrictions [ 10 ]. Recent reviews on the impact of heart failure self-management interventions highlight their beneficial effects in reducing rates of heart failure specific readmission and mortality, as well as improving heart failure-related quality of life [ 11 , 12 ].…”

Enhancing self‐care strategies in heart failure through patient‐reported outcome measures

“…Exercise training enhances myocardial function and exercise tolerance, improves ventilation and has favourable effects on haemodynamics in HF. 17 Existing paper-based self-monitoring methods are inefficient, difficult to share and poorly adhered to. 15 The HF-ACTION randomised control trial found that exercise was associated with a 13% risk reduction in HF mortality and hospitalisations.…”

“…14 Moreover, exercise training has a favourable effect on symptoms (MLWHF Questionnaire general well-being score 2.6 AE 1.4 vs 4.0 AE 0.5, P < 0.01). 17 Electronic platforms have an increasingly relevant role in the provision of healthcare. 16 Recent studies suggest feasibility of mobile technology in self-monitoring physical activity trends and have demonstrated enhanced participation and motivation.…”

“…16 Recent studies suggest feasibility of mobile technology in self-monitoring physical activity trends and have demonstrated enhanced participation and motivation. 17 Existing paper-based self-monitoring methods are inefficient, difficult to share and poorly adhered to. 17 Electronic platforms have an increasingly relevant role in the provision of healthcare.…”

“…17 Existing paper-based self-monitoring methods are inefficient, difficult to share and poorly adhered to. 17 Electronic platforms have an increasingly relevant role in the provision of healthcare. Telemonitoring has an established role in reducing all-cause mortality 18 and HF hospitalisations in the HF population.…”