Trajectories and influencing factors of self-care behaviors in Chinese older adults with chronic heart failure: A prospective observational study

Background

Self-care is crucial for improving the quality of life of patients with chronic heart failure. Self-care behaviors change over time, and the trajectories differ among patients with varying characteristics. However, the trajectories of self-care behaviors in older adults with chronic heart failure have not been fully studied.

Objective

This study aimed to identify the trajectory patterns of self-care behaviors over 3 months after hospital discharge in Chinese older adults with chronic heart failure, as well as the factors influencing these patterns.

Methods

A prospective observational study was conducted from October 2022 to July 2023, involving 255 older adults with chronic heart failure recruited from a tertiary hospital in Shanghai, China. Demographic and clinical information, self-care behaviors, self-care confidence, illness perception, self-efficacy, social support, and heart failure knowledge were investigated using a validated questionnaire and electronic health records at baseline, 2 weeks, 4 weeks, 2 months, and 3 months post-discharge. Growth mixture modeling was used to identify the trajectory patterns of self-care behaviors. Logistic regression was used to determine the influencing factors of different trajectory patterns.

Results

The best-fit growth mixture modeling revealed a 2-class model for self-care maintenance: “sustained good” group and “poor-gradually improving” group; a 3-class model for symptom perception: “gradually decreasing”, “persistently poor”, and “poor-gradually improving” groups; and a 3-class model for self-care management: “poor-gradually improving”, “sustained good”, and “early boost then decline” groups. Self-care confidence, heart failure knowledge, economic level, and the source of medical expenses were determinants of the different trajectory patterns in self-care behaviors.

Conclusion

This study enhances the understanding of the diverse behavioral trajectory patterns exhibited by Chinese older adults with chronic heart failure, as well as the factors that influence these patterns. Tailored interventions that focus on the unique needs of diverse groups should be developed to sustain satisfactory self-care behaviors.