The relationship between self-care, long-term mortality, and heart failure hospitalization: insights from a real-world cohort study

Abstract

Abstract Aims The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). Methods and results We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988–0.997), P-value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981–0.996), P-value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988–0.998), P-value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991–0.999), P-value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201–2.127), P-value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114–1.923), P-value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140–1.923), P-value = 0.006] were all associated with higher risk of all-cause mortality. Conclusion In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.