Trajectories of self-care and task execution abilities among older patients with chronic heart failure following a nurse-led intervention: A longitudinal mixed-effects analysis

Aim and objectives: To examine longitudinal changes in self-care ability and task execution ability among older patients with chronic heart failure following a nurse-led age-friendly graded symptom-recognition intervention. Background: Older patients with chronic heart failure often experience difficulties in symptom recognition, response selection, and sustained self-management after discharge. Although self-care has been widely emphasized in heart failure management, less is known about how nurse-led interventions influence the development of both self-care ability and task execution ability over time, particularly during the vulnerable post-discharge transition period. Design: This study was a secondary analysis based on a previously published randomized controlled trial protocol in older patients with chronic heart failure recruited from a tertiary hospital. Participants were originally assigned to either a nurse-led age-friendly graded symptom-recognition intervention plus usual care or usual care alone. The present analysis focused on behavioral outcomes within the first 3 months after discharge. Methods: Self-care ability and task execution ability were assessed at baseline, 1 month, and 3 months after discharge. Self-care ability was measured using the Chinese version of the European Heart Failure Self-care Behaviour Scale (EHFScBS-9), and task execution ability was evaluated using a structured task performance scale assessing key self-management tasks. Longitudinal trajectories were analysed using linear mixed-effects models. Results: For self-care ability, significant main effects of group and time were observed, along with a significant group × time interaction (F_group = 11.65, P < 0.001; F_time = 5.74, P = 0.003; F_interaction = 8.10, P < 0.001). The standardized interaction effect increased from modest at 1 month (β ≈ 0.30) to large at 3 months (β ≈ 1.00). For task execution ability, no significant group main effect was observed (F_group = 0.01, P = 0.91), whereas significant time and interaction effects were detected (F_time = 36.19, P < 0.001; F_interaction = 26.91, P < 0.001). The interaction effect was moderate at 1 month (β ≈ 0.65) and large at 3 months (β ≈ 1.35). Conclusions: A nurse-led age-friendly graded symptom-recognition intervention was associated with improved longitudinal patterns of both self-care ability and task execution ability among older patients with chronic heart failure. These findings suggest that structured symptom-recognition support may strengthen patients' ability to translate symptom cues into appropriate self-management actions during the vulnerable post-discharge transition period.