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  • Review Article
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Self care in patients with chronic heart failure

Nature Reviews Cardiology volume 8, pages 644–654 (2011)Cite this article

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Abstract

'Heart failure self care' refers to the practices in which patients engage to maintain their own health, and to the decisions that they make about managing signs or symptoms. In this article, we base our discussion of self care in chronic heart failure on the classification of patients as being 'expert', inconsistent', or 'novice' in heart failure self-care behaviors. The available literature on factors predicting heart failure self care and its outcomes are reviewed within this context. Factors known to influence heart failure self care include experience with the illness, physical functioning, depression and anxiety, social support, daytime sleepiness, and attitudes such as confidence. Further research is needed to understand the contributions of comorbidities, patient sex, and health disparities on heart failure self care. The evidence to support a link between heart failure self care and health outcomes is limited, but early evidence suggests that adequate self care is associated with an improvement in health status, a decrease in the number and duration of hospitalizations, and a decline in levels of biomarkers of stress and inflammation, and in intrathoracic impedance. Implications of heart failure self care for clinical practice, policy, and public health are also described.

Key Points

  • 'Heart failure self care' refers to the practices in which patients engage to maintain their own health, and to the decisions they make about managing signs or symptoms

  • We have identified a natural gradient in heart failure self-care behaviors referred to as 'expert', 'inconsistent', and 'novice'

  • A multitude of situational (experience, knowledge), physical (functional abilities, sleepiness), psychological (depression, attitudes), social (social support), and clinical (cognitive) factors affect heart failure self care

  • Evidence to support a link between heart failure self care and health outcomes is limited and, despite some accumulation of data, more research is required in this area

  • Since much of the current literature on heart failure self care is limited by small samples with little diversity, research is sorely needed in large and diverse populations

  • Interventions to improve heart failure self care should be personalized to address barriers, enhance self efficacy, and focus on the development of skill in early recognition, monitoring, and management of signs and symptoms

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Figure 1: Model of heart failure self care.
Figure 2: Using the novice-to-expert typology of heart failure self care, we have identified several areas that consistently predict 'expertise', 'inconsistency', or 'novice' ability in heart failure self care.
Figure 3: Integrated model of known predictors and outcomes of heart failure self care.
Figure 4: Patient self-care management scores (measured with the Self-Care of Heart Failure Index) and the odds of having plasma levels above the sample median of both N-terminal pro-B-type natriuretic peptide and soluble tumor necrosis factor receptor type 1 are shown.
Figure 5: Intrathoracic impedance and heart failure self care.

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References

  1. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks [online], (2009).

  2. Lloyd-Jones, D. et al. Heart disease and stroke statistics—2010 update. a report from the American Heart Association. Circulation 121, 948–954 (2010).

    Article  PubMed  Google Scholar 

  3. American Heart Association. International Cardiovascular Disease Statistics [online]. (2009).

  4. Roger, V. L. et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation 123, e18–e209 (2011).

    PubMed  Google Scholar 

  5. Shafazand, M., Schaufelberger, M., Lappas, G., Swedberg, K. & Rosengren, A. Survival trends in men and women with heart failure of ischaemic and non-ischaemic origin: data for the period 1987–2003 from the Swedish Hospital Discharge Registry. Eur. Heart J. 30, 671–678 (2009).

    PubMed  Google Scholar 

  6. Huffman, M. D. & Prabhakaran, D. Heart failure: epidemiology and prevention in India. Natl Med. J. India 23, 283–288 (2010).

    PubMed  PubMed Central  Google Scholar 

  7. Sliwa, K. et al. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet 371, 915–922 (2008).

    Article  PubMed  Google Scholar 

  8. Riegel, B. et al. Psychometric testing of the self-care of heart failure index. J. Card. Fail. 10, 350–360 (2004).

    PubMed  Google Scholar 

  9. Orasanu, J. & Connolly, T. in Decision making in action: models and methods (eds Klein, G., Orasanu, J., Calderwood, R. & Zsambok, C.) 3–20 (Ablex Publishing, 1993).

    Google Scholar 

  10. Klein, G. Naturalistic decision making. Hum. Factors 50, 456–460 (2008).

    PubMed  Google Scholar 

  11. Jaarsma, T., Strömberg, A., Mårtensson, J. & Dracup, K. Development and testing of the European Heart Failure Self-Care Behaviour Scale. Eur. J. Heart Fail. 5, 363–370 (2003).

    CAS  PubMed  Google Scholar 

  12. Riegel, B., Lee, C. S., Dickson, V. V. & Carlson, B. An update on the self-care of heart failure index. J. Cardiovasc. Nurs. 24, 485–497 (2009).

    PubMed  PubMed Central  Google Scholar 

  13. Dickson, V. V., Deatrick, J. A. & Riegel, B. A typology of heart failure self-care management in non-elders. Eur. J. Cardiovasc. Nurs. 7, 171–181 (2008).

    PubMed  Google Scholar 

  14. Riegel, B., Vaughan Dickson, V., Goldberg, L. R. & Deatrick, J. A. Factors associated with the development of expertise in heart failure self-care. Nurs. Res. 56, 235–243 (2007).

    PubMed  Google Scholar 

  15. Riegel, B. et al. From novice to expert: confidence and activity status determine heart failure self-care performance. Nurs. Res. 60, 132–138 (2011).

    PubMed  Google Scholar 

  16. Dickson, V. & Riegel, B. Are we teaching what patients need to know? Building skills in heart failure self-care. Heart Lung 38, 253–261 (2009).

    PubMed  Google Scholar 

  17. Cameron, J. et al. Does cognitive impairment predict poor self-care in patients with heart failure? Eur. J. Heart Fail. 12, 508–515 (2010).

    PubMed  Google Scholar 

  18. Strömberg, A. The crucial role of patient education in heart failure. Eur. J. Heart Fail. 7, 363–369 (2005).

    PubMed  Google Scholar 

  19. Ni, H. et al. Factors influencing knowledge of and adherence to self-care among patients with heart failure. Arch. Intern. Med. 159, 1613–1619 (1999).

    CAS  PubMed  Google Scholar 

  20. Sneed, N. V. & Paul, S. C. Readiness for behavioral changes in patients with heart failure. Am. J. Crit. Care 12, 444–453 (2003).

    PubMed  Google Scholar 

  21. Cline, C. M., Björck-Linne, A. K., Israelsson, B. Y., Willenheimer, R. B. & Erhardt, L. R. Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. Eur. J. Heart Fail. 1, 145–149 (1999).

    CAS  PubMed  Google Scholar 

  22. Rogers, A. et al. A qualitative study of chronic heart failure patients' understanding of their symptoms and drug therapy. Eur. J. Heart Fail. 4, 283–287 (2002).

    PubMed  Google Scholar 

  23. Horowitz, C. R., Rein, S. B. & Leventhal, H. A story of maladies, misconceptions and mishaps: effective management of heart failure. Soc. Sci. Med. 58, 631–643 (2004).

    PubMed  PubMed Central  Google Scholar 

  24. Clark, A. et al. Patient and informal caregivers knowledge of heart failure: necessary but insufficient for effective self-care. Eur. J. Heart Fail. 11, 617–621 (2009).

    PubMed  Google Scholar 

  25. Riegel, B. & Carlson, B. Facilitators and barriers to heart failure self-care. Patient Educ. Couns. 46, 287–295 (2002).

    PubMed  Google Scholar 

  26. Carlson, B., Riegel, B. & Moser, D. K. Self-care abilities of patients with heart failure. Heart Lung 30, 351–319 (2001).

    CAS  PubMed  Google Scholar 

  27. Riegel, B. et al. Symptom recognition in elders with heart failure. J. Nurs. Scholarsh. 42, 92–100 (2010).

    PubMed  Google Scholar 

  28. Gallagher, R. Self management, symptom monitoring and associated factors in people with heart failure living in the community. Eur. J. Cardiovasc. Nurs. 9, 153–160 (2010).

    PubMed  Google Scholar 

  29. Moser, D. K., Doering, L. V. & Chung, M. L. Vulnerabilities of patients recovering from an exacerbation of chronic heart failure. Am. Heart J. 150, 984 (2005).

    PubMed  Google Scholar 

  30. Jurgens, C. Y. Somatic awareness, uncertainty, and delay in care-seeking in acute heart failure. Res. Nurs. Health 29, 74–86 (2006).

    PubMed  Google Scholar 

  31. Baas, L. S., Beery, T. A., Allen, G., Wizer, M. & Wagoner, L. E. An exploratory study of body awareness in persons with heart failure treated medically or with transplantation. J. Cardiovasc. Nurs. 19, 32–40 (2004).

    PubMed  Google Scholar 

  32. Jurgens, C. Y., Fain, J. A. & Riegel, B. Psychometric testing of the heart failure somatic awareness scale. J. Cardiovasc. Nurs. 21, 95–102 (2006).

    PubMed  Google Scholar 

  33. Cameron, O. G. Interoception: the inside story—a model for psychosomatic processes. Psychosom. Med. 63, 697–710 (2001).

    CAS  PubMed  Google Scholar 

  34. Bennett, S., Hays, L., Embree, J. & Arnould, M. Heart messages: a tailored message intervention for improving heart failure outcomes. J. Cardiovasc. Nurs. 14, 94–105 (2000).

    CAS  PubMed  Google Scholar 

  35. Hicks, F. & Holm, K. Self-management decision influences in heart failure: a preliminary investigation. Clin. Nurs. Res. 12, 69–84 (2003).

    PubMed  Google Scholar 

  36. Wu, J., Moser, D., Chung, M. & Lennie, T. Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. J. Card. Fail. 14, 603–614 (2008).

    PubMed  PubMed Central  Google Scholar 

  37. Molloy, G. J. et al. Adherence to angiotensin-converting-enzyme inhibitors and illness beliefs in older heart failure patients. Eur. Heart J. 11, 715–720 (2009).

    CAS  Google Scholar 

  38. Riegel, B. & Dickson, V. V. A situation-specific theory of heart failure self-care. J. Cardiovasc. Nurs. 23, 190–196 (2008).

    PubMed  Google Scholar 

  39. van der Bijl, J. & Shortridge-Baggett, L. The theory and measurement of the self-efficacy construct. Sch. Inq. Nurs. Pract. 15, 189–207 (2001).

    CAS  PubMed  Google Scholar 

  40. Rohrbaugh, M. J. et al. Beyond the “self” in self-efficacy: spouse confidence predicts patient survival following heart failure. J. Fam. Psychol. 18, 184–193 (2004).

    PubMed  Google Scholar 

  41. Joekes, K., Van Elderen, T. & Schreurs, K. Self-efficacy and overprotection are related to quality of life, psychological well-being and self-management in cardiac patients. J. Health Psychol. 12, 4–16 (2007).

    PubMed  Google Scholar 

  42. Rockwell, J. M. & Riegel, B. Predictors of self-care in persons with heart failure. Heart Lung 30, 18–25 (2001).

    CAS  PubMed  Google Scholar 

  43. Chriss, P. M., Sheposh, J., Carlson, B. & Riegel, B. Predictors of successful heart failure self-care maintenance in the first three months after hospitalization. Heart Lung 33, 345–353 (2004).

    PubMed  Google Scholar 

  44. Suwanno, J., Petpichetchian, W., Riegel, B. & Issaramalai, S. A. A model predicting health status of patients with heart failure. J. Cardiovasc. Nurs. 24, 118–126 (2009).

    PubMed  Google Scholar 

  45. Lee, C. S. et al. Gender differences in heart failure self-care: a multinational cross-sectional study. Int. J. Nurs. Stud. 46, 1485–1495 (2009).

    PubMed  PubMed Central  Google Scholar 

  46. Pressler, S. J. Cognitive functioning and chronic heart failure: a review of the literature J. Cardiovasc. Nurs. 23, 239–249 (2008).

    PubMed  Google Scholar 

  47. Pressler, S. J. et al. Cognitive deficits in chronic heart failure. Nurs. Res. 59, 127–139 (2010).

    PubMed  PubMed Central  Google Scholar 

  48. Woo, M. A., Macey, P. M., Fonarow, G. C., Hamilton, M. A. & Harper, R. M. Regional brain gray matter loss in heart failure. J. Appl. Physiol. 95, 677–684 (2003).

    PubMed  Google Scholar 

  49. Dickson, V. V., Tkacs, N. & Riegel, B. Cognitive influences on self-care decision making in persons with heart failure. Am. Heart J. 154, 424–431 (2007).

    PubMed  Google Scholar 

  50. Woo, M. A., Kumar, R., Macey, P. M., Fonarow, G. C. & Harper, R. M. Brain injury in autonomic, emotional, and cognitive regulatory areas in patients with heart failure. J. Card. Fail. 15, 214–223 (2009).

    PubMed  Google Scholar 

  51. Holzapfel, N. et al. Self-care and depression in patients with chronic heart failure. Heart Lung 38, 392–397 (2009).

    PubMed  Google Scholar 

  52. Luyster, F., Hughes, J. & Gunstad, J. Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator. J. Cardiovasc. Nurs. 24, 10–17 (2009).

    PubMed  Google Scholar 

  53. Sayers, S. L., Pawlowski, S., Coyne, J. C. & Samaha, F. Depression, social support, and medication adherence in heart failure functioning. Presented at the Annual Meeting of the Soc. of Behavioral Medicine 2005.

  54. Gallager, R., Luttik, M. L. & Jaarsma, T. Social support and self-care in heart failure. J. Cardiovasc. Nurs. doi: 10.1097/JCN.0b013e31820984e1.

  55. Dickson, V. V., Worrall-Carter, L., Kuhn, L. & Riegel, B. Whose job is it? Gender differences in perceived role in heart failure self-care. J. Nurs. Health Care Chron. Illn. 3, 99–108 (2011).

    Google Scholar 

  56. Harvey, R. C. & Altevogt, B. M. (Eds) Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem (National Academy Press, 2006).

    Google Scholar 

  57. Riegel, B. et al. Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure. J. Card. Fail. 17, 340–348 (2011).

    PubMed  Google Scholar 

  58. Joynt, K. E., Whellan, D. J. & O'Connor, C. M. Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. J. Card. Fail. 10, 258–271 (2004).

    PubMed  Google Scholar 

  59. Freedland, K. E. et al. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom. Med. 65, 119–128 (2003).

    PubMed  Google Scholar 

  60. MacMahon, K. & Lip, G. Psychological factors in heart failure: A review of the literature. Arch. Intern. Med. 162, 509–516 (2002).

    PubMed  Google Scholar 

  61. Cameron, J., Worrall-Carter, L., Riegel, B., Sing, K. & Stewart, S. Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure. Heart Lung 38, 410–418 (2009).

    PubMed  Google Scholar 

  62. Moser, D. K. & Worster, P. L. Effect of psychosocial factors on physiologic outcomes in patients with heart failure. J. Cardiovasc. Nurs. 14, 106–115 (2000).

    CAS  PubMed  Google Scholar 

  63. DiMatteo, M. R. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med. Care 42, 200–209 (2004).

    PubMed  Google Scholar 

  64. Hansen, R. et al. Depression affects adherence measurement but not the effectiveness of an adherence intervention in heart failure patients. J. Am. Pharm. Assoc. 49, 760–768 (2009).

    Google Scholar 

  65. Schiffer, A. A., Denollet, J., Widdershoven, J. W., Hendriks, E. H. & Smith, O. R. Failure to consult for symptoms of heart failure in patients with a type-D personality. Heart 93, 814–818 (2007).

    PubMed  PubMed Central  Google Scholar 

  66. Jaarsma, T. et al. Design and methodology of the COACH study: a multicenter randomised Coordinating study evalutating Outcomes of Advising and Counselling in Heart failure. Eur. J. Heart Fail. 6, 227–233 (2004).

    PubMed  Google Scholar 

  67. Johansson, P., Nieuwenhuis, M., Lesman-Leegte, I., van Veldhuisen, D. & Jaarsma, T. Depression and the delay between symptom onset and hospitalization in heart failure patients. Eur. J. Heart Fail. 13, 214–219 (2010).

    PubMed  Google Scholar 

  68. Dickson, V. V., Buck, H. & Riegel, B. A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. J. Card. Fail. 17, 413–419 (2011).

    PubMed  Google Scholar 

  69. McEntee, M. L., Cuomo, L. R. & Dennison, C. R. Patient-, provider-, and system-level barriers to heart failure care. J. Cardiovasc. Nurs. 24, 290–298 (2009).

    PubMed  Google Scholar 

  70. Riegel, B. et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation 120, 1141–1163 (2009).

    PubMed  Google Scholar 

  71. Chung, M. L. et al. Gender differences in adherence to the sodium-restricted diet in patients with heart failure. J. Card. Fail. 12, 628–634 (2006).

    PubMed  PubMed Central  Google Scholar 

  72. Artinian, N. T, Magnan, M., Sloan, M. & Lange, M. P. Self-care behaviors among patients with heart failure. Heart Lung 31, 161–172 (2002).

    PubMed  Google Scholar 

  73. Heo, S., Moser, D. K., Lennie, T. A., Riegel, B. & Chung, M. L. Gender differences in and factors related to self-care behaviors: a cross-sectional, correlational study of patients with heart failure. Int. J. Nurs. Stud. 45, 1807–1815 (2008).

    PubMed  PubMed Central  Google Scholar 

  74. Holst, M., Willenheimer, R., Mårtensson, J., Lindholm, M. & Strömberg, A. Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. Eur. J. Cardiovasc. Nurs. 6, 153–159 (2007).

    PubMed  Google Scholar 

  75. Riegel, B., Dickson, V. V., Kuhn, L., Page, K. & Worrall-Carter, L. Gender-specific barriers and facilitators to heart failure self-care: a mixed methods study. Int. J. Nurs. Stud. 47, 888–895 (2010).

    PubMed  Google Scholar 

  76. Riegel, B. et al. Heart failure self-care in developed and developing countries. J. Card. Fail. 15, 508–516 (2009).

    PubMed  PubMed Central  Google Scholar 

  77. Macabasco-O'Connell, A., Crawford, M. H., Stotts, N., Stewart, A. & Froelicher, E. S. Self-care behaviors in indigent patients with heart failure. J. Cardiovasc. Nurs. 23, 223–230 (2008).

    PubMed  Google Scholar 

  78. DeWalt, D. A. et al. Development and pilot testing of a disease management program for low literacy patients with heart failure. Patient Educ. Couns. 55, 78–86 (2004).

    PubMed  Google Scholar 

  79. Lainscak, M. et al. Nonpharmacologic measures and drug compliance in patients with heart failure: data from the EuroHeart Failure Survey. Am. J. Cardiol. 99, 31D–37D (2007).

    PubMed  Google Scholar 

  80. Michalsen, A., König, G. & Thimme, W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 80, 437–441 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Hauptman, P. J. Medication adherence in heart failure. Heart Fail. Rev. 13, 99–106 (2008).

    PubMed  Google Scholar 

  82. O'Connor, C. M. et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301, 1439–1450 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  83. Ditewig, J. B., Blok, H., Havers, J. & van Veenendaal, H. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: a systematic review. Patient Educ. Couns. 78, 297–315 (2010).

    PubMed  Google Scholar 

  84. McAlister, F. A., Stewart, S., Ferrua, S. & McMurray, J. J. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J. Am. Coll. Cardiol. 44, 810–819 (2004).

    PubMed  Google Scholar 

  85. Jovicic, A., Holroyd-Leduc, J. M. & Straus, S. E. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovasc. Disord. 6, 43 (2006).

    PubMed  PubMed Central  Google Scholar 

  86. Lee, C. S., Suwanno, J. & Riegel, B. The relationship between self-care and health status domains in Thai patients with heart failure. Eur. J. Cardiovasc. Nurs. 8, 259–266 (2009).

    PubMed  PubMed Central  Google Scholar 

  87. Granger, B. B. et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. Lancet 366, 2005–2011 (2005).

    CAS  PubMed  Google Scholar 

  88. van der Wal, M. H., van Veldhuisen, D. J., Veeger, N. J., Rutten, F. H. & Jaarsma, T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur. Heart J. 31, 1486–1493 (2010).

    PubMed  Google Scholar 

  89. Lee, C. S., Moser, D. K., Lennie, T. A. & Riegel, B. Event-free survival in adults with heart failure who engage in self-care management. Heart Lung 40, 12–20 (2011).

    PubMed  Google Scholar 

  90. DeWalt, D. A. et al. A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170]. BMC Health Serv. Res. 6, 30 (2006).

    PubMed  PubMed Central  Google Scholar 

  91. Powell, L. H. et al. Self-management counseling in patients with heart failure: the heart failure adherence and retention randomized behavioral trial. JAMA 304, 1331–1338 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  92. Kupper, N., Gidron, Y., Winter, J. & Denollet, J. Association between type D personality, depression, and oxidative stress in patients with chronic heart failure. Psychosom. Med. 71, 973–980 (2009).

    CAS  PubMed  Google Scholar 

  93. Gardner, R. S., Ozalp, F., Murday, A. J., Robb, S. D. & McDonagh, T. A. N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur. Heart J. 24, 1735–1743 (2003).

    CAS  PubMed  Google Scholar 

  94. Ueland, T. et al. Plasma levels of soluble tumor necrosis factor receptor type I during the acute phase following complicated myocardial infarction predicts survival in high-risk patients. J. Am. Coll. Cardiol. 46, 2018–2021 (2005).

    CAS  PubMed  Google Scholar 

  95. Lee, C. S. et al. Biomarkers of myocardial stress and systemic inflammation are lower in patients who engage in heart failure self-care management. J. Cardiovasc. Nurs. 26, 321–328 (2011).

    PubMed  PubMed Central  Google Scholar 

  96. Wang, L. Fundamentals of intrathoracic impedance monitoring in heart failure. Am. J. Cardiol. 99, 3G–10G (2007).

    PubMed  Google Scholar 

  97. Rathman, L. D., Lee, C. S., Sarkar, S. & Small, R. S. A critical link between heart failure self-care and intrathoracic impedance. J. Cardiovasc. Nurs. 26, E20–E26 (2011).

    PubMed  Google Scholar 

  98. Lee, C. S., Tkacs, N. C. & Riegel, B. The Influence of Heart Failure Self-care on Health Outcomes: Hypothetical Cardioprotective Mechanisms. J. Cardiovasc. Nurs. 24, 179–187 (2009).

    PubMed  PubMed Central  Google Scholar 

  99. Grady, K. L. Self-care and quality of life outcomes in heart failure patients. J. Cardiovasc. Nurs. 23, 285–292 (2008).

    PubMed  Google Scholar 

  100. Eagle, K. A. et al. Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan. J. Am. Coll. Cardiol. 46, 1242–1248 (2005).

    PubMed  Google Scholar 

  101. Ford, E. S. et al. Explaining the decrease in U. S. deaths from coronary disease, 1980–2000. N. Engl. J. Med. 356, 2388–2398 (2007).

    CAS  PubMed  Google Scholar 

  102. Azevedo, A. et al. Population based study on the prevalence of the stages of heart failure. Heart 92, 1161–1163 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Wang, T. J., Levy, D., Benjamin, E. J. & Vasan, R. S. The epidemiology of “asymptomatic” left ventricular systolic dysfunction: implications for screening. Ann. Intern. Med. 138, 907–916 (2003).

    PubMed  Google Scholar 

  104. Hunt, S. A. et al. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. J. Am. Coll. Cardiol. 53, e1–e90 (2009).

    PubMed  Google Scholar 

  105. Dickstein, K. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur. Heart J. 29, 2388–2442 (2008).

    CAS  PubMed  Google Scholar 

  106. Lindenfeld, J. et al. HFSA 2010 comprehensive heart failure practice guideline. J. Card. Fail. 16, e1–e194 (2010).

    PubMed  Google Scholar 

  107. Göhler, A. et al. Decision-analytic evaluation of the clinical effectiveness and cost-effectiveness of management programmes in chronic heart failure. Eur. J. Heart Fail. 10, 1026–1032 (2008).

    PubMed  Google Scholar 

  108. Lainscak, M. et al. Self-care management of heart failure: practical recommendations from the patient care committee of the Heart Failure Association of the European Society of Cardiology. Eur. J. Heart Fail. 13, 115–126 (2011).

    PubMed  Google Scholar 

  109. Riegel, B. et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation 120, 1141–1163 (2009).

    PubMed  Google Scholar 

  110. Centers for Medicare & Medicaid Services. Hospital Inpatient Quality Reporting Program [online] (2011).

  111. Fonarow, G. C. et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA 297, 61–70 (2007).

    CAS  PubMed  Google Scholar 

  112. Patterson, M. E. et al. Process of care performance measures and long-term outcomes in patients hospitalized with heart failure. Med. Care 48, 210–216 (2010).

    PubMed  PubMed Central  Google Scholar 

  113. McCarthy, M. M., Vaughan Dickson, V. & Chyun, D. Barriers to cardiac rehabilitation in women with cardiovascular disease: an integrative review. J. Cardiovasc. Nurs. doi:10.1097/jcn.0b013e3181f877e9.

  114. Centers for Disease Control and Prevention. Perceptions of neighborhood characteristics and leisure-time physical inactivity—Austin/Travis County, Texas, 2004. MMWR Morb. Mortal. Wkly Rep. 54, 926–928 (2005).

  115. Chung, M. et al. Patients differ in their ability to self-monitor adherence to a low-sodium diet versus medication. J. Card. Fail. 14, 114–120 (2008).

    PubMed  Google Scholar 

  116. Mattes, R. & Donnelly, D. Relative contributions of dietary sodium sources. J. Am. Coll. Nutr. 10, 383–393 (1991).

    CAS  PubMed  Google Scholar 

  117. Appel, L. J. et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation 123, 1138–1143 (2011).

    PubMed  Google Scholar 

  118. Inglis, S. C. et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD007228. doi:10.1002/14651858.CD007228.pub2 (2010).

  119. Bowles, K. H., Riegel, B., Weiner, M. G., Glick, H. & Naylor, M. D. The effect of telehomecare on heart failure self care. AMIA Annu. Symp. Proc. 2010, 71–75 (2010).

    PubMed  PubMed Central  Google Scholar 

  120. Yancy, C. W., Fonarow, G. C. & ADHERE Scientific Advisory Committee. Quality of care and outcomes in acute decompensated heart failure: The ADHERE Registry. Curr. Heart Fail. Rep. 1, 121–128 (2004).

    PubMed  Google Scholar 

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Acknowledgements

B. Riegel received grant/research support from NHLBI (HL084394-01A1), C. S. Lee received grant/research support from National Institute of Nursing Research and the Office of Research on Women's Health, and V. D. Dickson received grant/research support from the American Heart Association. L. Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217, PA, USA

    Barbara Riegel

  2. Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, 97239-2941, OR, USA

    Christopher S. Lee

  3. College of Nursing, New York University, 726 Broadway, New York, 10003, NY, USA

    Victoria Vaughan Dickson

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  1. Barbara Riegel
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  2. Christopher S. Lee
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  3. Victoria Vaughan Dickson
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All authors researched data and wrote the article, contributed substantially to the discussion of content, and reviewed and edited the manuscript before submission.

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Correspondence to Barbara Riegel.

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The authors declare no competing financial interests.

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Riegel, B., Lee, C. & Dickson, V. Self care in patients with chronic heart failure. Nat Rev Cardiol 8, 644–654 (2011). https://doi.org/10.1038/nrcardio.2011.95

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