title: Event-free survival in adults with heart failure who engage in self-care management.
abstract: BACKGROUND
  Self-care management in heart failure (HF) involves decision-making to evaluate, and actions to ameliorate symptoms when they occur. This study sought to compare the risks of all-cause mortality, hospitalization, or emergency-room admission among HF patients who practice above-average self-care management, those who practice below-average self-care management, and those who are symptom-free.
  
  
  METHODS
  A secondary analysis was conducted of data collected on 195 HF patients. A Cox proportional hazards model was used to examine the association between self-care management and event risk.
  
  
  RESULTS
  The sample consisted of older (mean ± standard deviation=61.3 ± 11 years), predominantly male (64.6%) adults, with an ejection fraction of 34.7% ± 15.3%; 60.1% fell within New York Heart Association class III or IV HF. During an average follow-up of 364 ± 288 days, 4 deaths, 82 hospitalizations, and 5 emergency-room visits occurred as first events. Controlling for 15 common confounders, those who engaged in above-average self-care management (hazard ratio, .44; 95% confidence interval, .22 to .88; P < .05) and those who were symptom-free (hazard ratio, 0.48; 95% confidence interval, .24 to .97; P < .05) ran a lower risk of an event during follow-up than those engaged in below-average self-care management.
  
  
  CONCLUSIONS
  Symptomatic HF patients who practice above-average self-care management have an event-free survival benefit similar to that of symptom-free HF patients.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. csleern@gmail.com
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
mesh_terms: D003657:Decision Making; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011379:Prognosis; D016016:Proportional Hazards Models; D011594:Psychometrics; D018570:Risk Assessment; D012648:Self Care; D011795:Surveys and Questionnaires; D016019:Survival Analysis