What is the clinical evidence from this study?

Study design: Observational. Population: Chronic Heart Failure (n=460). Intervention: Self-care behaviors. Primary outcome: Glomerular filtration rate of creatinine (GFRcreat) (β = -0.14, p=0.023).

November 21, 2019Open Access

Self-Care and Pathophysiological Function in Patients with Chronic Heart Failure

Key Result

Better global self-care was independently associated with lower glomerular filtration rate of creatinine (β = -0.14, P = 0.023), suggesting that increased self-care may reflect worsening renal function.

Study Design

Type

Observational (n=460)

Multicenter

Yes

Structured PICO

Does self-reported HF self-care improve HF-associated pathophysiological markers in patients with chronic heart failure?

Population

Patients with chronic heart failure

Intervention

Self-reported HF self-care (including regular exercise, medication adherence, restriction of fluid and sodium, and daily weight monitoring)

Outcome

HF-associated pathophysiological markers, including renal, hematological, and immune function (including hemoglobin, TNF-alpha, IL-10)surrogate

While exercise and medication adherence are associated with improved physiological functioning, fluid and sodium restriction may be associated with adverse pathophysiological biomarker levels in chronic heart failure.

Main Result

Effect estimate: β = -0.14

p-value: p=0.023

Limitations

Self-care was assessed by self-report, which may not reflect actual behavior.
Single items were used to examine individual self-care behaviors.
Cytokine levels were assessed in a subsample of patients characterized by better cardiac function.
Random slopes were not examined, which could have resulted in an inflated type-I error rate.
Patients with complete data were in better cardiac condition and with fewer comorbidities than patients who dropped out.

Abstract

BACKGROUND: Self-care is assumed to benefit physiological function associated with prognosis in patients with chronic HF, but studies examining these relations are lacking. This study aims to prospectively examine the association of self-reported HF self-care with HF-associated pathophysiological markers, including renal, hematological, and immune function. METHOD: ), and hemoglobin (Hb), controlling for sociodemographic and clinical covariates. RESULTS: (P = .014). Low-sodium intake was associated with lower levels of Hb (P = .027), lower TNF-alpha (P = .011), and lower IL-10 (P = .029). Higher levels of medication adherence were associated with reduced pro-inflammatory activation (P < .007). CONCLUSION: Our findings suggest that better global self-care was associated with poorer renal function. Performing self-care behaviors such as regular exercise and medication adherence was associated with improved physiological functioning, while restriction of fluid and sodium, and the associated daily weight monitoring were associated with adverse levels of pathophysiological biomarkers.

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