Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: findings from the Heart and Soul Study.
OBJECTIVE
The authors sought to evaluate the association of self-efficacy with objective measures of cardiac function, subsequent hospitalization for heart failure (HF), and all-cause mortality.


METHODS
Observational cohort of ambulatory patients with stable CHD. The authors measured self-efficacy using a published, validated, 5-item summative scale, the Sullivan Self-Efficacy to Maintain Function Scale. The authors also performed a cardiac assessment, including an exercise treadmill test with stress echocardiography.


METHODS
Hospitalizations for HF, as determined by blinded review of medical records, and all-cause mortality, with adjustment for demographics, medical history, medication use, depressive symptoms, and social support.


RESULTS
Of the 1,024 predominately male, older CHD patients, 1013 (99%) were available for follow-up, 124 (12%) were hospitalized for HF, and 235 (23%) died during 4.3 years of follow-up. Mean cardiac self-efficacy score was 9.7 (SD 4.5, range 0-20), corresponding to responses between "not at all confident" and "somewhat confident" for ability to maintain function. Lower self-efficacy predicted subsequent HF hospitalization (OR per SD decrease = 1.4, p = .0006), and all-cause mortality (OR per SD decrease = 1.4, p < .0001). After adjustment, the association of cardiac self-efficacy with both HF hospitalization and mortality was explained by worse baseline cardiac function.


CONCLUSIONS
Among patients with CHD, self-efficacy was a reasonable proxy for predicting HF hospitalizations. The increased risk of HF associated with lower baseline self-efficacy was explained by worse cardiac function. These findings indicate that measuring cardiac self-efficacy provides a rapid and potentially useful assessment of cardiac function among outpatients with CHD.
Sarkar
Urmimala
U
Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, Box 1732, San Francisco, CA 94143-1732, USA. urmimalasarkar@yahoo.com
Ali
Sadia
S
Whooley
Mary A
MA
D002423:Cause of Death; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000523:psychology*; D023921:Coronary Stenosis / Q000401:mortality / Q000523:psychology; D003863:Depression / Q000523:psychology; D025401:Echocardiography, Stress; D005080:Exercise Test; D005500:Follow-Up Studies; D015438:Health Behavior; D006333:Heart Failure / Q000401:mortality / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D009203:Myocardial Infarction / Q000401:mortality / Q000523:psychology; D017202:Myocardial Ischemia / Q000401:mortality / Q000523:psychology; D009204:Myocardial Revascularization / Q000401:mortality / Q000523:psychology; D010555:Personality Inventory; D011446:Prospective Studies; D012307:Risk Factors; D012495:San Francisco; D020377:Self Efficacy; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000523:psychology*