Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis.
Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.
PhD Student, School of Nursing, Oregon Health & Science University, Mail code: SN-2N, 3455 SW US Veterans Hospital Road, Portland, OR, 97239-2941, USA.
Julie T
JT
Bidwell
Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Ercole
E
Vellone
Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
Karen S
KS
Lyons
Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Fabio
F
D'Agostino
Professor, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Barbara
B
Riegel
Research Fellow, Faculty of Health Science, University of San Jorge, Zaragoza, Spain.
Raúl
R
Juárez-Vela
Research Associate, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
Shirin O
SO
Hiatt
Research Associate, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Rosaria
R
Alvaro
Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
Christopher S
CS
Lee
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D017028:Caregivers / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D007398:Interpersonal Relations; D007558:Italy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011788:Quality of Life; D012648:Self Care / Q000706:statistics & numerical data*; D017678:Sex Distribution
cardiac; caregivers; chronic disease; dyad; heart failure; self-care; self-care maintenance; self-care management