Predictores de conductas de autocuidado en individuos con insuficiencia cardiaca en Brasil

Silva, Marco Antonio Gomes da; Brunori, Evelise Helena Fadini Reis; Murakami, Beatriz Murata; D´Agostino, Fábio; Lopes, Camila Takao; Santos, Vinicius Batista; Santos, Eduarda Ribeiro dos

doi:10.1590/1983-1447.2023.20220357.en

Brasil

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Original Article • Rev. Gaúcha Enferm. 44 • 2023 • https://doi.org/10.1590/1983-1447.2023.20220357.en linkcopiar

Predictores de conductas de autocuidado en individuos con insuficiencia cardiaca en Brasil

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: Identificar los predictores de conductas de autocuidado en individuos con insuficiencia cardíaca.

Método: Estudio transversal con 405 pacientes con insuficiencia cardíaca. Se evaluaron comportamientos de autocuidado por el Self-Care of Heart Failure Index. Se investigaron características sociodemográficas y clínicas como predictores del mantenimiento, manejo y confianza en el autocuidado a través de regresiones logísticas.

Resultados: Los predictores de automantenimiento fueron número de hijos (p<0,01), fracción de eyección del ventrículo izquierdo (p<0,01), sentimiento positivo sobre la enfermedad (p=0,03), obesidad (p=0,02) y enfermedad renal crónica dialítica (p<0,01). Predictores del autogestión fueron hijos casados (p<0,01) y apnea del sueño (p<0,01). Predictores de autoconfianza fueron renta familiar (p<0,01), número de internaciones en los últimos 12 meses (p=0,01), número de dosis diarias de medicamentos (p<0,01) e inactividad física (p<0,01).

Conclusión: Se encontraron algunos predictores relacionados con autocuidado, por lo que se debe intensificar la educación y ayuda social dirigida a pacientes con estas características.

Descriptores: Insuficiencia cardíaca; Autocuidado; Automanejo; Conductas relacionadas con la salud; Enfermería

Variable	N(%)
Male Gender	232(57.3)
Age	54.77(10.83)*
Self-declared ethnicity
Mixed (Caucasian + African American)	146(36.0)
Caucasian	142(35.1)
African American	115(28.4)
Asian	2(0.5)
Marital Status
Married or in a stable union	262(64.7)
Single	67(16.5)
Divorced	45(11.1)
Widowed	31(7.7)
Number of children	2(2;3) †
Schooling
Complete or incomplete High School	193(47.7)
Complete or incomplete Elementary School	166(41.0)
Complete or incomplete Higher Education	46(11.3)
Religion
Catholic	230(56.8)
Evangelical	120(29.6)
Candomblé	31(7.6)
Atheist or no religion	16(4.0)
Others	8(2.0)
Work situation
Retired, unemployed, does not work or pensioner	209 (51.6)
Self-employed, employee or housewife	157 (38.8)
Medical leave	39(9.6)
Family income
1-3 minimum wages	305 (75.3)
Up to 1 minimum wage	66 (16.3)
3 or more minimum wages	34 (8.4)
Lived alone
Yes	40 (12.1)
Number of people living in the household
3-4	190 (46.9)
1-2	154 (38.0)
<5	61 (15.1)
Family care
Does not require care	348 (85.9)
Spouse	38 (9.4)
Children	19 (4.7)

Variable	n (%)
Etiology of Heart Failure
Idiopathic dilated cardiomyopathy	154(38.0)
Chagas’ disease	117(28.9)
Hypertensive cardiomyopathy	37(9.1)
Ischemic cardiomyopathy	31(7.7)
Others (alcoholic cardiomyopathy, peripartum cardiomyopathy, restrictive cardiomyopathy, amyloidosis, myocarditis and hypertrophic cardiomyopathy)	66(16.3)
Functional class
I	189(46.7)
II	188(46.4)
III	28(6.9)
Comorbidities*
Arterial hypertension	332(82.0)
Dyslipidemia	268(66.2)
Diabetes mellitus	119(29.4)
Obesity	118(29.1)
Chronic kidney disease	46(11.3)
Hypothyroidism	41(10.1)
Cancer	20(4.9)
Iron deficiency anemia	13(3.2)
Sleep apnea	8(2.0)
Lifestyle
Sedentarism	196(48.4)
Smoker
Ex-smoker	256(63.2)
Never smoked	115(28.4)
Smoker	34(8.4)
Alcohol consumption
Ex-alcoholic	200(49.4)
Never drank	134(33.1)
1- 4 weekly doses	51(12.6)
5+ weekly doses	20(4.9)
Hospitalized or sought medical care due to HF symptoms in the previous months	191(47.2)
Feeling about the disease
Negative	277(68.4)
Positive	41(10.1)
Did not know what to answer	87(21.5)
Time since diagnosis (years)	8.54±8.52†
Left ventricular ejection fraction (%)	42.20 ±13.76†
Number of hospitalizations	1(1-20) )§
Number of medications per day	8(0-26) )§

Variable	OR*	95% CI †	p-value
Self-care maintenance
Montreal Cognitive Assessment test	1.30	1.09-1.55	<0.01
Number of children	0.66	0.53-0.83	<0.01
Years of study
(In)Complete Elementary School§
(In)complete High School	0.29	0.13-0.64	0.002
Family income
Up to 1 minimum wage§
1-3 minimum wages	2.98	1.15-7.76	0.02
3 or more minimum wages	4.39	1.33-14.41	0.01
Hospitalization or seeking medical care in in the previous 12 months	0.40	0.23-0.69	<0.01
Number of hospitalizations due to HF in the previous 12 months	0.44	0.20-0.95	0.03
Left ventricular ejection fraction	1.06	1.04-1.08	<0.01
Total number of daily medication doses	0.83	0.77-0.94	<0.01
Arterial hypertension	0.43	0.24-0.77	<0.01
Dialytic chronic kidney disease	6.95	1.14-42.36	0.03
Non-dialytic chronic kidney disease	0.10	0.01-0.73	0.02
Dyslipidemia	0.37	0.22-0.63	<0.001
Obesity	0.36	0.18-0.72	<0.01
Sedentarism	0.35	0.20-0.61	<0.01
Smoker
Never smoked§
Ex-smoker	0.54	0.31-0.92	0.02
Smoker	0.27	0.07-0.96	0.04
Self-care management
Number of children	0.55	0.33-0.92	0.02
Family income
Up to 1 minimum wage§
1-3 minimum wages	2.36	0.28-19.39	0.04
3 or more minimum wages	10.84	1.04-113.16	0.04
Married children	0.124	0.027-0.58	<0.01
Sleep apnea	8.56	1.47-49.66	0.01
Chronic obstructive pulmonary disease	5.27	0.98-28.14
Self-care confidence
Montreal Cognitive Assessment	1.43	1.21-1.68	<0.001
Ethnicity
Caucasian§
Non-Caucasian	0.61	0.38-0.97	0.040
Number of children	0.78	0.64-0.94	0.009
Years of study
(In)Complete Elementary School§
(In)complete High School	1.78	1.07-2.97	0.02
(In)complete Higher Education	3.32	1.63-6.76	<0.01
Family income§
Up to 1 minimum wage§
1-3 minimum wages	5.70	2.01-16.16	0.001
3 or more minimum wages	12.37	3.62-41.31	<0.001
Hospitalization or seeking medical care in the previous 12 months	0.20	0.122-0.35	<0.001
Left ventricular ejection fraction	1.08	1.06-1.10	<0.001
Total number of daily medication doses	0.72	0.66-0.79	<0.001
Arterial hypertension	0.48	0.28-0.83	0.009
Diabetes Mellitus	0.33	0.18-0.61	<0.001
Non-dialytic chronic kidney disease	0.13	0.03-0.57	0.007
Dyslipidemia	0.32	0.20-0.52	<0.001
Obesity	0.40	0.22-0.72	0.002
Sedentarism	0.25	0.15-0.42	<0.001
Smoker
Never smoked§
Ex-smoker	0.46	0.28-0.75	<0.001
Smoker	0.30	0.10-0.83	0.02

Predictor	OR*	95% CI^†	p-value
Self-care Maintenance‡
Number of children	0.71	0.560-0.913	<0.01
Left ventricular ejection fraction	1.05	1.025-1.075	<0.01
Feeling about disease
Negative§
Positive	2.49	1.05-5.88	0.03
Neutral	2.24	1.11-4.49	0.02
Obesity	0.42	0.020-0.90	0.02
Dialytic chronic kidney disease	15.69	2.24-109.85	<0.01
Self-care management
Married child	0.09	0.01-0.50	<0.01
Sleep apnea	17.07	2.03-143.30	<0.01
Self-care confidence**
Family income
Up to 1 minimum wage§
1-3 minimum wages	5.26	1.66-16.67	<0.01
3 or more minimum wages	12.67	3.07-52.27	<0.01
Number of hospitalizations in the previous 12months	0.60	0.40-0.90	0.01
Left ventricular ejection fraction	1.05	1.02-1.07	<0.01
Number of daily medication doses	0.86	0.78-0.94	<0.01
Sedentarism	0.37	0.20-0.69	<0.01

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[TFN1] Source: Database, 2020

[TFN2] Note: * mean (standard deviation) ; † median (interquartile range).