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Poor self-care is prevalent in patients with heart failure and adversely affects heart failure symptoms, hospitalization, and mortality. Adherence rates to different types of self-care vary in patients with heart failure. The purpose of this study was to examine factors associated with medication adherence, dietary sodium adherence, and symptom management in patients with heart failure. Data were collected using questionnaires, Medication Electronic Monitoring System, and 24-hour urine sodium output (N = 94). In logistic regression analysis, social support, education level, and race were associated with medication adherence (p =.002). Gender, race, perceived control, and depressive symptoms were associated with dietary sodium adherence (p =.030). Gender, education level, and depressive symptoms were associated with symptom management (p =.006). Different factors were associated with each type of self-care. Thus, clinicians need to manage each type of self-care by considering factors associated with it. [ABSTRACT FROM AUTHOR]

Background: In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined. Objective: The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL. Methods: We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose. Results: Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R² = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R² = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-monthHRQOL. Conclusion: Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class. [ABSTRACT FROM AUTHOR]

Introduction: Mental health in patients (pts) with advanced heart failure (HF) who undergo implantation of mechanical circulatory support (MCS) is poorly described. Further research is needed to identify areas of risk and guide mental health-related therapies. The purpose of this report is to describe and compare mental health sub-domains at early, mid, and later time periods after durable MCS implantation with a left ventricular assist device. Methods: Using a cross-sectional design, we enrolled 238 MCS pts who were at least 3 months post implantation from 9 US sites between 10/26/16 - 11/21/17. Mental health sub-domains, assessed via self-report, were perception of anxiety and depression (PROMIS, v1.0), perception of cognitive function (PROMIS, v2.0), stigma (Neuro-QoL, modified), and spirituality (FACIT-Sp-12, v4). Pt characteristics and mental health sub-domains were compared across time periods with Chi-Square tests and ANOVAs. Results: The majority of pts were male, White, and well educated; age differed by time period post implant. Etiology of HF and implant strategy were similar among time periods. For all three time periods, anxiety and depression scores approximated the US general population mean (50). Cognitive function scores across the three time periods were also similar to the US general population mean (50). Pts at all time periods reported never to rarely experiencing stigma; pts >6mos-24mos post implant reported more stigma than pts earlier or later post implant. Pts at all time periods reported very good spiritual well-being; scores trended lower (worse) among pts >6-24 mos. post implant (Table). Conclusions: MCS pts at all three times post implant reported anxiety, depression, and cognitive function similar to that of the US general population. Spiritual well-being was high, and stigma was low, although it varied by time period. These findings may provide direction for mental health focused therapies after MCS implantation. [ABSTRACT FROM AUTHOR]