Effectiveness of Self-Care Management in Heart Failure Patients

Heart failure self-care management is a form of preventive medicine, in which patients assess their symptoms of heart failure and take appropriate measures to relieve those symptoms. Earlier studies have shown that self-care management increases the chances of survival in patients who suffer from chronic heart failure. In order to confirm this hypothesis, this study was conducted to assess the levels of substances in blood, which indicate the amount of stress on heart muscles and the level of inflammation in the body, in people who practice self-care management. Elevated levels of both these markers indicate a poor health outcome. This study found that “better self-care management was associated with reduced levels of markers of cardiac stress and systemic inflammation.”

Various studies have shown that self-care management improves the survival chances of heart failure patients. However, no studies have been done so far to investigate the mechanism behind this phenomenon. The principal causes for deterioration of health in patients with heart failure are inflammation and exertion of stress on the heart. Both of these can be measured by assessing the levels of different biomarkers in blood. The biomarker for cardiac stress is the pro-B type natriuretic peptide. The biomarker for inflammation is the soluble tumor necrosis factor. Heart failure self-care management can be evaluated by using a questionnaire known as the “Self-Care of Heart Failure Index”. In the present study, researchers examined how self-care management affects the levels of biomarkers of inflammation and cardiac stress.

* This study involved 168 patients who were suffering from heart failure. After collecting their demographic information, their body mass indices were measured. The information on associated diseases, type and degree of heart failure and the functional capacity of heart (left ventricular ejection fraction) was then collected.
* Blood samples were collected to measure the levels of markers of inflammation and cardiac stress.
* All the participants were given questionnaires to assess the level of heart failure self-care management.

* The mean age of participants was 58 years, and 65 percent of them were men. On a grade scale of one to four, 85 percent of participants were suffering from grade three level of cardiac failure. In more than 50 percent of the patients, coronary heart disease was the primary cause behind the development of cardiac failure.
* The average “self-care management score” was 62. The median level of pro-B type natriuretic peptide in blood was found to be 582.8 fmol/mL, while the median level of soluble tumor necrosis factor a receptor-1 in blood was found to be 1710.1 pg/mL.
* Better heart failure self-care management was associated with lower levels of both these markers. However, it was also found that the levels of these two biomarkers decreases with an increase in self-care management only up to a certain level, after which they increased with an increase in self-care management. Therefore, the highest levels of self-care management had higher levels of these markers.

Shortcomings/Next steps
In the present study, measurement of biomarkers and self-care management score was performed only once. Further follow-up measurements are necessary to confirm the findings of this study. Heart failure self-care management scores were measured using self-reported data, which is subjective. Further studies need to measure these scores in an objective way.

Heart failure self-care management involves proper decision making by the patient, when he suffers from symptoms of heart failure. Self-care management involves adjustment of sodium (salt) and fluid intake, along with decreasing the consumption of diuretics that reduce the volume of blood. This study confirms the findings of earlier studies, which showed that better heart failure self-care management reduces the risk of mortality and hospitalization due to cardiac complications. Through effective self-care management, inflammation and cardiac stress can be reduced, averting further complications in cardiovascular health. Therefore, patients suffering from cardiovascular weaknesses must be trained to recognize the symptoms of heart failure and take appropriate measures to reduce these symptoms.

For More Information:
Biomarkers of Inflammation and Stress on Heart Muscles in Patients Who Engage in Heart Failure Self-care Management
Publication Journal: Journal of Cardiovascular Nursing, 2011
By Christopher S. Lee, PhD; Debra K. Moser; Oregon Health and Science University School of Nursing, Oregon and University of Kentucky College of Nursing, Lexington

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