Evolution of self-care in patients with heart failure at the first outpatient return and three months after hospital discharge

Cunha, Debora Cristine Previde Teixeira da; Rossi, Lidia Aparecida; Dessote, Carina Aparecida Marosti; Bolela, Fabiana; Dantas, Rosana Aparecida Spadoti

doi:10.1590/1518-8345.4364.3440

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4364.3440 copy

Evolution of self-care in patients with heart failure at the first outpatient return and three months after hospital discharge^* * Paper extracted from doctoral dissertation “Self-care in patients with heart failure in the first three months after hospital discharge”, presented to Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1).

Method:

an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student’s t test and paired distribution (McNemar) with a significance level of 0.05.

Results:

we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales.

Conclusion:

self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.

Descriptors:
Heart Failure; Self Care; Nursing Care; Ambulatory Care; Health Education; Cardiology

Sociodemographic characteristics	Finished (n=137) %(n) / M (S.D.)^* * M (S.D.) = Mean (Standard Deviation);	Losses/Exits (n=20) %(n) / M (S.D.)^* * M (S.D.) = Mean (Standard Deviation);	p-value
Age (years old)	60.3 (11.8)	60.2 (12.7)	0.97^† † Student's t test
Income (in Reais)	1,640.2 (693.3)	1,883.9 (1,062.1)	0.19^† † Student's t test
Years of study	5.4 (4.3)	5.7 (4.1)	0.72^† † Student's t test
Gender			0.24^‡ ‡ Chi-square test;
Male	51.1 (70)	65.0 (13)
Marital status			0.81^‡ ‡ Chi-square test;
Married/Consensual union	62.8 (86)	60.0 (12)
Presence of caregiver			0.53^§ § Fisher's exact test
Yes	82.5 (113)	90.0 (18)
Days between discharge and first return	17.4 (15.1)	15.4 (11.2)	0.57^† † Student's t test
Etiology of HF			0.79^§ § Fisher's exact test
Ischemic	24.8 (³⁴34 Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239. doi: http://dx.doi.org/10.1016/j.jacc.2013.05.019 http://dx.doi.org/10.1016/j.jacc.2013.05... )	20.0 (4)
Chagasic	21.9 (³⁰30 Sayers SL, Riegel B, Pawlowski S, Coyne JC, Samaha FF. Social support and self-care of patients with heart failure. Ann Behav Med. 2008;35(1):70-9. doi: http://dx.doi.org/10.1007/s12160-007-9003-x http://dx.doi.org/10.1007/s12160-007-900... )	30.0 (6)
Valve-related	13.9 (19)	20.0 (4)
LVEF^\|\| \|\| LVEF = Left Ventricular Ejection Fraction;			0.90^§ § Fisher's exact test
Preserved	17.5 (24)	20.0 (4)
Intermediate	4.4 (6)	0
Reduced	78.1 (107)	80.0 (16)
Decompensation profile			0.61^§ § Fisher's exact test
Profile B	73.0 (100)	65.0 (13)
Number of comorbidities	3.3 (1.9)	3.4 (1.6)	0.91^† † Student's t test
Self-reported CF NYHA^¶ ¶ CF NYHA = Functional classification of the New York Heart Association
Class I	11.7 (16)	27.0 (37)	0.70^§ § Fisher's exact test
Class II	50.4 (69)	60.0 (12)
Class III	27.0 (37)	20.0 (4)
Class IV	10.9 (15)	15.0 (3)

SCHFI^* * SCHFI = Self-care of Heart Failure Index; domains	T0 M (S.D.)^† † M (S.D.) Mean (Standard Deviation);	T1 M (S.D.)^† † M (S.D.) Mean (Standard Deviation);	p-value^‡ ‡ Student's t test	T0 Cronbach's Alpha	T1 Cronbach's Alpha
Maintenance	39.1 (16.4)	56.8 (14.4)	0.001	0.54	0.64
Management	34.0 (27.3)	47.9 (26.5)	0.001	0.78	0.86
Confidence	46.2 (26.4)	58.5 (26.3)	0.001	0.87	0.90

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Rosana Aparecida Spadoti Dantas. E-mail: rsdantas@eerp.usp.br