title: Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure.
abstract: OBJECTIVE
  This study examined the association of self-care with all-cause mortality in a cohort of patients with chronic heart failure (HF).
  
  
  BACKGROUND
  Although self-care is crucial to maintain health in patients with chronic HF, studies examining an association with clinical outcomes are scarce.
  
  
  METHODS
  Consecutive patients with chronic HF (n = 559, mean age 66.3 ± 9.5 years, 78% men) completed the 9-item European Heart Failure Self-care Behaviour scale. Our endpoint was all-cause mortality. Associations between self-care and all-cause mortality were assessed with Kaplan-Meier analyses and multivariable Cox regression accounting for standard sociodemographic and clinical covariates, psychological distress, and self-rated health.
  
  
  RESULTS
  After a median follow-up of 5.5 ± 2.4 years (range 16 weeks to 9.9 years), 221 deaths (40%) from any cause were recorded. There was no evidence of a mortality benefit in patients high over those low in global self-care (p = 0.71). In post hoc analyses, low self-reported sodium intake was associated with increased mortality (adjusted hazard ratio: 1.47; 95% confidence interval: 1.10 to 1.96; p = 0.01). Other significant predictors of mortality were: male sex, lack of a partner, New York Heart Association functional class III to IV, and increasing comorbid conditions.
  
  
  CONCLUSIONS
  Global self-care was not associated with long-term mortality whereas low self-reported sodium intake independently predicted increased all-cause mortality beyond parameters of disease severity. Replication of findings is needed as well as studies examining the correspondence of subjectively and objectively measured sodium intake and its effects on long-term prognosis in patients with chronic HF.
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.
authors.forename: Dionne
authors.initials: D
authors.lastname: Kessing
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg/Waalwijk, the Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Widdershoven
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands. Electronic address: h.m.kupper@tilburguniversity.edu.
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
mesh_terms: D000368:Aged; D001835:Body Weight / Q000502:physiology; D002423:Cause of Death; D002908:Chronic Disease; D004039:Diet, Sodium-Restricted / Q000401:mortality; D015444:Exercise / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000401:mortality*; D057566:Self Report; D016019:Survival Analysis
keywords: heart failure; mortality; self-care; sodium intake; survival