Background: Both heart failure (HF) symptoms and self-care management (i.e. patient responses to symptom when they occur) are associated with important patient outcomes. Although it is thought symptoms drive self-management, results of studies examining these relationships are inconsistent and primarily of cross-sectional designs.
Hypothesis: Symptom severity would be significantly associated with changes in HF self-care management over 6 months.
Method: Latent mixture analysis was used to identify natural-occurring sub-groups based on physical symptoms of dyspnea, sleepiness, and edema (HF Somatic Perception Scale - dyspnea and edema subscales; Epworth Sleepiness Scale). Latent growth modeling was then used to determine how self-care management behaviors (Self-care of HF Index - self-care management score) over 6 months differed by symptom sub-group. Socio-demographic and clinical variables predicting likelihood of sub-group membership were identified using multivariate logistic regression.
Results: The sample (n = 146) was on average 57 years old, 70% men and 59% NYHA class III/IV. A high symptom group (16% of sample) with no significant change over time (high persistent) and low symptom group (84% of sample) with no significant change in symptoms over time (low persistent) were identified (entropy = 0.91). The high persistent group was associated with better self-care management behaviors at baseline (β = 13.5 ± 4.5, p < 0.01); self-care management did not improve over time in either sub-group (high persistent slope = -2.4 ± 2.3, p = 0.3; low persistent slope = -0.05 ± 0.9, p = 0.9). That is, patients experiencing high persistent symptoms reported high and sustained self-management over 6 months while those with persistently low symptom burden were persistently less engaged in self-management. Being female (OR = 3.5 ± 1.9, p < 0.05) and having more depression (OR = 1.1 ± 0.05, p < 0.01) were associated with increased odds of being in the high persistent symptom and self-care management group.
Conclusion: Patients bothered more by symptoms are consistently more engaged in self-care management behaviors over 6 months. Results of this study support symptoms as an important driver of self-care management behaviors.