Self-care trajectories of patients with coronary heart disease: a longitudinal, observational study

Author:

Ingadóttir Brynja1ORCID,Svavarsdóttir Margrét Hrönn2ORCID,Jurgens Corrine Y3ORCID,Lee Christopher S3ORCID

Affiliation:

1. Faculty of Nursing and Midwifery, University of Iceland and Landspitali - the National University Hospital of Iceland , Eiriksgata 34, 101 Reykjavik , Iceland

2. Faculty of Nursing, University of Akureyri , Akureyri , Iceland

3. William F. Connell School of Nursing, Boston College , Chestnut Hill, MA , USA

Abstract

Abstract Aims To determine if distinct trajectories of coronary heart disease (CHD) self-care behaviours could be identified, linked to differences in quality of life (QoL), and predicted based on baseline characteristics. Methods and results A secondary analysis of a prospective, longitudinal, observational study. Patients with CHD answered questionnaires at study enrolment and six months later: Self-Care of Coronary Heart Disease Inventory (three subscales: maintenance, management, and confidence, scored 0–100, higher score = better self-care), Hospital Anxiety and Depression Scale, 12-Item Short Form Survey, 16-Item European Health Literacy Survey Questionnaire, and CHD Education Questionnaire. Latent growth mixture modelling was used to identify distinct self-care trajectories over time. On average, patients (n = 430, mean age 64.3 ± 8.9, 79% male) reported inadequate self-care (maintenance 61.6 ± 15.4, management 53.5 ± 18.5) at enrolment. Two distinct trajectories of self-care behaviours were identified: first, an ‘inadequate-and-worsening’ (IN-WORSE) trajectory (57.2%), characterized by inadequate self-care, improvement in maintenance (4.0 ± 14.5-point improvement, P < 0.001), and worsening of management over time (6.3 ± 24.4-point worsening, P = 0.005). Second, an ‘inadequate-but-maintaining’ (IN-MAIN) trajectory (42.8%), characterized by inadequate self-care, improvement in maintenance (5.0 ± 16.2-point improvement, P < 0.001), and stability in management over time (0.8 ± 21.9-point worsening, P = 0.713). In comparison, patients in the IN-WORSE trajectory had less favourable characteristics (including lower health literacy, knowledge, confidence) and significantly lower QoL. Not attending rehabilitation (OR 2.175; CI 1.020–4.637, P = 0.044) and older age (OR 0.959; CI 0.924–0.994, P = 0.024) predicted (IN-WORSE) trajectory inclusion. Conclusion Two self-care trajectories were identified, both suboptimal. Rehabilitation predicted membership in the more favourable trajectory and some positive characteristics were identified among patients in that group. Therefore, interventions supporting these factors may benefit patients’ self-care and QoL.

Funder

Icelandic Regional Development Institute

Landspitali University Hospital

University of Akureyri

Icelandic Nursing Association Research Fund

Akureyri Heart Association

Publisher

Oxford University Press (OUP)

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