Symptom trajectories and self-care patterns in chronic obstructive pulmonary disease and heart failure.

BACKGROUND: Persons living with chronic cardiopulmonary conditions, namely Chronic Obstructive Pulmonary Disease or Heart Failure, experience groups of negative symptoms when recovering from acute exacerbations or decompensations from their conditions. It remains unknown whether an association between self-care performance and symptom trajectories experienced during this period exists. OBJECTIVES: This secondary analysis examined how self-care performance associates with previously identified symptom trajectories in a sample of persons who were recovering from an exacerbation of either COPD or HF over a 2-month period. METHODS: The present study utilized a multi-step analytic plan, where self-care performance was first modeled at baseline and over time utilizing latent growth mixture modeling procedures. Following, the resulting latent intercept and slope estimate of each self-care domain was input into a hierarchical logistic regression model, where belonging to one of two previously identified symptom trajectories was regressed onto self-care performance and select covariates. RESULTS: The latent self-care monitoring intercept and slope estimate were the only self-care domain scores that were associated with experiencing symptom trajectories. Particularly, those with increased self-care monitoring over time were less likely to experience the moderate overall symptom trajectory (OR = 0.78, 95% CI of OR [0.61, 0.99], p < 0.01). CONCLUSION: Clinicians should promptly assess self-care monitoring ability of persons who may be recovering from an acute exacerbation or decompensation state, as those living with these chronic cardiopulmonary conditions who report poor ability to perform this domain of self-care may be more likely to report increased symptom burden over time.