title: Trajectories of heart failure self-care management and changes in quality of life.
abstract: BACKGROUND
  Heart failure patients vary considerably in their self-care management behaviors (i.e. recognizing and responding to symptoms). The goal of this study was to identify unique patterns of change in heart failure self-care management and quantify associations between self-care management and quality of life (HRQOL) over time.
  
  
  METHODS
  A prospective cohort study among adults with symptomatic heart failure was designed to measure changes in self-care management (Self-care of Heart Failure Index) and HRQOL (Kansas City Cardiomyopathy Questionnaire) over six months. Growth mixture modeling was used to identify unique trajectories of change in self-care management.
  
  
  RESULTS
  The mean age (n=146) was 57 years, 70% were male, and 41% had class II heart failure. Two trajectories of self-care management were identified (entropy = 0.88). The larger trajectory (73.3%) was characterized by a significant decline in self-care management over time and no change in HRQOL. The smaller trajectory (26.7%) was characterized by marked improvements in self-care management and HRQOL. Changes in heart failure self-care management occurred in the absence of change in routine self-care maintenance behaviors, functional classification, and physical and psychological symptoms. Patients with greater physical symptoms at enrollment (odds ratio (OR) =1.04, p=0.037), larger left ventricles (OR=1.50, p=0.044), and ischemic heart failure (OR=3.84, p=0.014) were more likely to have the declining trajectory of self-care management. Higher levels of depression at enrollment were associated with reduced odds of having a decline in self-care management over time (OR=0.85, p<0.001).
  
  
  CONCLUSIONS
  There are unique and clinically-relevant trajectories of change in heart failure self-care management that are associated with differences in HRQOL.
authors: Oregon Health & Science University School of Nursing and Knight Cardiovascular Institute, Portland, USA csleern@gmail.com.
authors: Christopher S
authors: CS
authors: Lee
authors: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA.
authors: James O
authors: JO
authors: Mudd
authors: Oregon Health & Science University School of Nursing, Portland, USA.
authors: Shirin O
authors: SO
authors: Hiatt
authors: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA.
authors: Jill M
authors: JM
authors: Gelow
authors: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA.
authors: Christopher
authors: C
authors: Chien
authors: University of Pennsylvania School of Nursing, Philadelphia, USA.
authors: Barbara
authors: B
authors: Riegel
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012648:Self Care; D012720:Severity of Illness Index; D012737:Sex Factors; D018434:Sickness Impact Profile; D014481:United States
keywords: Heart failure; quality of life; self-care; symptom management