Post-Discharge Self-Care Confidence and Performance Levels in Hospitalized Heart Failure Patients

Abstract

Background: Multidisciplinary self-care education plays a critical role in ensuring the high-quality transitional care of hospitalized heart failure (HF) patients. However, whether confidence on self-care during their index hospitalization would influence their post-discharge self-care performance and long-term outcomes remains uncertain.

Methods: We conducted an assessment of 100 consecutive HF patients who completed self-care questionnaires both during their hospitalization and one year after discharge. Within these hospitalized HF patients, self-care confidence was assessed immediately after completing their pre-discharge educational program. One year after the index hospitalization, we evaluated self-care performance using European Heart Failure Self-care Behavior Scale. Logistic regression analysis was employed to identify determinants of poor self-care behavior 1-year after the hospitalization. Additionally, the Cox proportional hazards model with adjustment for Seattle Heart Failure Model was applied to assess their association with 2-year mortality and readmission risk.

Results: The enrolled patients predominantly had HF with reduced ejection fraction (43.0%), and approximately half of the patients had experienced a previous HF hospitalization (47.0%). The three worst-performing aspects of post-discharge self-care behavior (among the 12 items) were appropriate consultation for fatigue (40.0%), weight gain (52.0%), and application of regular exercise (57.0%). After adjustment, low self-care confidence during the index hospitalization were associated with poor post-discharge self-care performance (OR: 1.11, CI: 1.00-1.21). Poor post-discharge self-care behavior was not associated with a worse prognosis over a 2-year follow-up (hazard ratio [HR]: 1.82, CI: 0.85-3.86); however, the association was significant in patients with reduced ejection fraction (HR: 4.04, CI: 1.17-13.89) and previous HF hospitalization (HR: 3.66, CI: 1.46-9.13).

Conclusions: Post-discharge self-care performance was associated with self-care confidence during the index HF hospitalization. Effective measures that improve pre-discharge confidence levels in self-care should be considered to enhance the quality of transitional care.

Keywords: 1-year follow-up; heart failure; patient education; patient perspective; self-care.