title: Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study.
abstract: BACKGROUND
  Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component.
  
  
  OBJECTIVE
  The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF.
  
  
  METHODS
  In a cross-sectional study of 318 patients with chronic systolic HF recruited in 48 German primary care practices, we evaluated the patient-reported European HF Self-care Behaviour scale (EHFScBs) assessments (range 12-60, where lower scores indicate better self-care). Potential determinants included socio-demographic (e.g. age, living status), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, co-morbidities), behavioural (e.g. smoking and alcohol intake), psychosocial (SF-36 scales and KCCQ domains, e.g. quality of life and self-efficacy) and depression status (PHQ-D), plus previous health care utilisation. Mixed regression modelling was applied.
  
  
  RESULTS
  Patients had a mean (SD) age of 69.0 (10.4) years and were 71% male. They had a good overall EHFScBs score of 24.7 (7.8) (n=274). In the final regression model (n=271), six determinants were retained (β; descriptive p-value): self-efficacy (-0.24; <.001), age (-0.22; <.001), prosthetic heart valve (-0.14; .01), referrals to cardiologists (-0.14; .02), peripheral arterial disease (0.13; .03) and quality of life (0.16; .02).
  
  
  CONCLUSIONS
  In this exploratory cross-sectional study, the potential non-modifiable and modifiable risk factors and resources involved in patients' HF self-care were at the individual and organisational level. Self-efficacy and quality of life are potentially modifiable, so these could be targeted for improvement by enhancing patient motivation, HF education and further supporting a collaborative care approach.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany. frank.peters-klimm@med.uni-heidelberg.de
authors.forename: F
authors.initials: F
authors.lastname: Peters-Klimm
authors.forename: T
authors.initials: T
authors.lastname: Freund
authors.forename: C U
authors.initials: CU
authors.lastname: Kunz
authors.forename: G
authors.initials: G
authors.lastname: Laux
authors.forename: L
authors.initials: L
authors.lastname: Frankenstein
authors.forename: T
authors.initials: T
authors.lastname: Müller-Tasch
authors.forename: J
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care; D012959:Socioeconomic Factors