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Self-care and Quality of Life of Heart Failure Patients at a Multidisciplinary Heart Function Clinic

Seto, Emily MSc, PEng; Leonard, Kevin J. PhD, MBA; Cafazzo, Joseph A. PhD, PEng; Masino, Caterina MA; Barnsley, Jan PhD; Ross, Heather J. MD, MHSc, FRCPC

doi: 10.1097/JCN.0b013e31820612b8
ARTICLES: Heart Failure

Background: Multidisciplinary heart function clinics aim to improve self-care through patient education and to provide clinical management.

Objective: The objectives of the present study were to investigate the self-care and quality of life of patients attending a multidisciplinary heart function clinic and to explore the relationship between self-care and quality of life.

Methods: One hundred outpatients attending a multidisciplinary heart function clinic were asked to complete a questionnaire. The questionnaire included the Self-care of Heart Failure Index (SCHFI) and the Minnesota Living With Heart Failure Questionnaire, which were used to assess self-care behavior and quality of life, respectively. Self-care practices and perceived barriers were also assessed through semistructured interviews with each patient.

Results: The returned questionnaires (n = 94) were used to compute the following SCHFI maintenance, management, and confidence scores: 60.8 (SD, 19.3), 62.0 (SD, 20.7), and 55.9 (SD, 19.7), respectively. Higher SCHFI scores indicate better self-care. None of the self-care dimensions reached the self-care adequacy cut point of 70. The average score on the Minnesota Living With Heart Failure Questionnaire was 49.9 (SD, 25.4), indicating a moderate health-related quality of life. Lower ejection fraction, older age, and better quality of life were associated with better self-care. Determinants of better quality of life were older age, better functional capacity, higher self-care confidence, and fewer comorbidities. The patient interviews revealed that better quality of life is associated with higher self-care confidence and barriers to self-care caused anxiety to the patients. The self-care barriers were found to include lack of self-care education, financial constraints, lack of perceived benefit, and low self-efficacy.

Conclusions: Patients attending a large multidisciplinary Canadian heart failure clinic do not perform adequate self-care as measured with the SCHFI and report only a moderate quality of life. Increasing self-care through education and tools that target self-care barriers are required and may help improve quality of life.

Emily Seto, MSc, PEng Biomedical Engineer, Centre for Global eHealth Innovation, University Health Network, Toronto; and PhD Candidate, Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.

Kevin J. Leonard, PhD, MBA Associate Professor, Department of Health Policy, Management and Evaluation, University of Toronto; and Research Scientist, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada.

Joseph A. Cafazzo, PhD, PEng Centre Lead, Centre for Global eHealth Innovation, University Health Network, Toronto; Assistant Professor, Department of Health Policy, Management and Evaluation, University of Toronto; and Assistant Professor, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario, Canada.

Caterina Masino, MA Analyst, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada.

Jan Barnsley, PhD Associate Professor, Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.

Heather J. Ross, MD, MHSc, FRCPC Associate Professor, Faculty of Medicine, University of Toronto; and Director, Divisions of Cardiology and Transplant, University Health Network, Toronto, Ontario, Canada.

Funding for this work was in part provided by the Toronto General Hospital Foundation and the NSERC Strategic Research Network in Healthcare Support through Information Technology Enhancements (hSITE).

The authors have no conflicts of interest to disclose.

Correspondence Emily Seto, MSc, PEng, 190 Elizabeth St, 4th Floor RFE Bldg, Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4 (emily.seto@uhn.on.ca).

© 2011 Lippincott Williams & Wilkins, Inc.