Effects of a Periodic Assessment of Heart Failure and Depressive Symptoms on Self-Care in Outpatients with Heart Failure: A Randomized Controlled Trial
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Abstract
Background: Periodic symptom assessment in outpatient settings may enhance self-care in heart failure (HF) patients, though its effects are not fully studied. This study examined the impact of periodic HF and depressive symptom assessments on self-care (maintenance, symptom perception, and management) over nine months.
Methods: In this randomized controlled trial, symptom assessments were conducted in the intervention group at baseline and at three, six, and nine months in South Korea between Sep 2022 and Nov 2023. Data on self-care were collected at baseline and at nine-month follow-up. A series of two-way repeated measures analysis of variance were used to address the purpose.
Results: The only variable that showed a significant difference between the intervention group (n=17, age=64.8 yr) and the control group (n=21, age=64.6 yr) from baseline to nine-month follow-up was self-care maintenance. The main effect of time on self-care maintenance was statistically significant, improving from baseline to follow-up regardless of group (F[1,36])=26.53, P<0.001). A significant group-by-time interaction (F[1,36] = 26.53, P=0.015) indicated the changes in self-care maintenance varied over time by group membership.
Conclusion: A periodic assessment of HF symptoms and depressive symptoms increased self-care maintenance, but did not affect other self-care behaviors, in outpatients with HF. Clinicians may consider regular outpatient symptom assessment as a tool for educational support to enhance self-care maintenance in patients with HF.
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2. Heo S, Kang J, Shin MS, et al. (2023). Physi-cal symptoms, depressive symptoms, and quality of life in patients with heart failure: Cluster analysis. J Cardiovasc Nurs :39(1):31-37.
3. Jering K, Claggett B, Redfield MM, et al (2021). Burden of heart failure signs and symptoms, prognosis, and response to therapy: The PARAGON-HF trial. JACC Heart Fail, 9(5), 386–397.
4. Heo S, Moser DK, Pressler SJ, et al (2015). Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardi-ovasc Nurs, 30(2), 136–44.
5. Sbolli M, Fiuzat M, Cani D, et al (2020). Depression and heart failure: The lonely comorbidity. Eur J Heart Fail, 22(11), 2007–2017.
6. Certo Pereira J, Presume J, Araujo I, et al (2023). Depression and heart failure – the incidence of depressive symptoms as-sessed by the PHQ9 and their association with HF outcomes. Eur Heart J, 44(Supplement_2).
7. Duan J, Huang K, Zhang X, et al (2022). Role of depressive symptoms in the prog-nosis of heart failure and its potential clin-ical predictors. ESC Heart Fail, 9(4), 2676–2685.
8. Mulugeta H, Sinclair PM, Wilson A (2023). Prevalence of depression and its associa-tion with health-related quality of life in people with heart failure in low- and mid-dle-income countries: A systematic review and meta-analysis. PLoS One, 18(3), e0283146.
9. Qiu C, Yu DS-F, Song D, et al (2022). The prognostic impact of symptom clusters in patients with heart failure: A systematic re-view and meta-analysis. J Adv Nurs, 78(9), 2713–2730.
10. Auld JP, Mudd JO, Gelow JM, et al (2018). Patterns of heart failure symptoms are as-sociated with self-care behaviors over 6 months. Eur J Cardiovasc Nurs, 17(6), 543–551.
11. Lee KS, Moser DK, Dracup K (2018). Rela-tionship between self-care and compre-hensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs, 17(6):496-504.
12. Wang Z, Tocchi C, Chyun D, et al (2023). The association between psychological factors and self-care in patients with heart failure: an integrative review. Eur J Cardio-vasc Nurs, 22(6):553-561.
13. Liu X, Liu L, Li Y, et al (2023). The associa-tion between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study. BMC Cardiovasc Disord, 23(1):205.
14. Negarandeh R, Aghajanloo A, Seylani K (2021). Barriers to self-care among patients with heart failure: a qualitative study. J Car-ing Sci, 10(4):196-204.
15. Lee CS, Gelow JM, Mudd JO, et al (2015). Profiles of self-care management versus consulting behaviors in adults with heart failure. Eur J Cardiovasc Nurs, 14(1):63-72.
16. Graven LJ, Grant JS, Gordon G (2015). Symptomatology and coping resources predict self-care behaviors in middle to older age patients with heart failure. Nurs Res Pract, 2015:840240.
17. Ferreira JP, Metra M, Mordi I, et al (2019). Heart failure in the outpatient versus inpa-tient setting: findings from the BIOSTAT-CHF study. Eur J Heart Fail, 21(1):112-120.
18. Walsh M, Bowen E, Vaughan C, et al (2023). Heart failure symptom burden in outpa-tient cardiology: observational cohort study. BMJ Support Palliat Care, 13(e3):e1280-e1284.
19. Pobrotyn P, Mazur G, Kałużna-Oleksy M, et al (2021). The level of self-care among patients with chronic heart failure. Healthcare (Basel), 9(9):1179.
20. Girerd N, Mewton N, Tartiere JM, et al (2022). Practical outpatient management of worsening chronic heart failure. Eur J Heart Fail, 24(5):750-761.
21. Taniguchi C, Seto N, Shimizu Y (2021). Outpatient nursing support for self-monitoring in patients with chronic heart failure. PLoS One, 16(7):e0254019.
22. Liljeroos M, Kato NP, van der Wal MHL, et al (2020). Trajectory of self-care behav-iour in patients with heart failure: the im-pact on clinical outcomes and influencing factors. Eur J Cardiovasc Nurs, 19(5):421-432.
23. Schäfer-Keller P, Santos GC, Denhaerynck K, et al (2021). Self-care, symptom experi-ence, needs, and past health-care utiliza-tion in individuals with heart failure: results of a cross-sectional study. Eur J Cardiovasc Nurs, 20(5):464-474.
24. Campbell RT, Willox GP, Jhund PS, et al (2016). Reporting of lost to follow-up and treatment discontinuation in pharma-cotherapy and device trials in chronic heart failure: a systematic review. Circ Heart Fail, 9(5):e002842.
25. Heo S, An M, Kim J (2017). Validation of the symptom status questionnaire-heart failure in Korean patients. Appl Nurs Res, 38:141-146.
26. Kroenke K, Spitzer RL (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann, 32(9):509-515.
27. Hammash MH, Hall LA, Lennie TA, et al (2013). Psychometrics of the PHQ-9 as a measure of depressive symptoms in pa-tients with heart failure. Eur J Cardiovasc Nurs, 12(5):446-53.
28. Shin C, Ko YH, An H, et al (2020). Norma-tive data and psychometric properties of the Patient Health Questionnaire-9 in a na-tionally representative Korean population. BMC Psychiatry, 20(1):194.
29. Han C, Jo SA, Kwak JH, et al (2008). Valida-tion of the patient health questionnaire-9 Korean version in the elderly population: the Ansan geriatric study. Compr Psychiatry, 49(2):218-23.
30. Kim J, Kim KH, Lim YH, et al (2022). Va-lidity and reliability of the Korean version of the revised self-care of heart failure in-dex v7.2. Clin Nurs Res, 31(7):1296-1307
31. Riegel B, Barbaranelli C, Carlson B, et al (2019). Psychometric testing of the revised self-care of heart failure index. J Cardiovasc Nurs, 34(2):183-192.
32. Vellone E, De Maria M, Iovino P, et al (2020). The self-care of heart failure index version 7.2: Further psychometric testing. Res Nurs Health, 43(6):640-650.
33. Charlson M, Wells MT, Ullman R, et al (2014). The Charlson comorbidity index can be used prospectively to identify pa-tients who will incur high future costs. PLoS One, 9(12):e112479.
34. World Medical Association (2013). World Medical Association Declaration of Hel-sinki: ethical principles for medical re-search involving human subjects. JAMA, 310(20):2191-4.
35. Yu S, Lee H (2024). Mediating effects of depressive symptoms and uncertainty on physical symptoms and self-care in Kore-an older men with heart failure. J Nurs Res, 32(6):e364.
36. Azad N, Lemay G (2014). Management of chronic heart failure in the older popula-tion. J Geriatr Cardiol, 11(4):329-37.
37. Heidenreich PA, Bozkurt B, Aguilar D, et al (2022). 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A re-port of the American College of Cardiolo-gy/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
38. McDonagh TA, Metra M, et al (2022). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart fail-ure. Eur J Heart Fail, 24(1):4-131. doi:10.1002/ejhf.2333
39. Riegel B (n.d.). Self-care of heart failure index – Patient version. Available from: https://self-care-measures.com/project/patient-version-schfi-english-v7-2/ (Accessed Aug 14, 2024)
40. Lee KS, Choi JO, Jeon ES, et al (2019). Dis-tinct factors associated with better self-care in heart failure patients with and without mild cognitive impairment. J Cardiovasc Nurs, 34(6):440-447.
41. Aghajanloo A, Negarandeh R, Janani L, et al (2021). Self-care status in patients with heart failure: Systematic review and meta-analysis. Nurs Open, 8(5):2235-2248.
2. Heo S, Kang J, Shin MS, et al. (2023). Physi-cal symptoms, depressive symptoms, and quality of life in patients with heart failure: Cluster analysis. J Cardiovasc Nurs :39(1):31-37.
3. Jering K, Claggett B, Redfield MM, et al (2021). Burden of heart failure signs and symptoms, prognosis, and response to therapy: The PARAGON-HF trial. JACC Heart Fail, 9(5), 386–397.
4. Heo S, Moser DK, Pressler SJ, et al (2015). Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardi-ovasc Nurs, 30(2), 136–44.
5. Sbolli M, Fiuzat M, Cani D, et al (2020). Depression and heart failure: The lonely comorbidity. Eur J Heart Fail, 22(11), 2007–2017.
6. Certo Pereira J, Presume J, Araujo I, et al (2023). Depression and heart failure – the incidence of depressive symptoms as-sessed by the PHQ9 and their association with HF outcomes. Eur Heart J, 44(Supplement_2).
7. Duan J, Huang K, Zhang X, et al (2022). Role of depressive symptoms in the prog-nosis of heart failure and its potential clin-ical predictors. ESC Heart Fail, 9(4), 2676–2685.
8. Mulugeta H, Sinclair PM, Wilson A (2023). Prevalence of depression and its associa-tion with health-related quality of life in people with heart failure in low- and mid-dle-income countries: A systematic review and meta-analysis. PLoS One, 18(3), e0283146.
9. Qiu C, Yu DS-F, Song D, et al (2022). The prognostic impact of symptom clusters in patients with heart failure: A systematic re-view and meta-analysis. J Adv Nurs, 78(9), 2713–2730.
10. Auld JP, Mudd JO, Gelow JM, et al (2018). Patterns of heart failure symptoms are as-sociated with self-care behaviors over 6 months. Eur J Cardiovasc Nurs, 17(6), 543–551.
11. Lee KS, Moser DK, Dracup K (2018). Rela-tionship between self-care and compre-hensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs, 17(6):496-504.
12. Wang Z, Tocchi C, Chyun D, et al (2023). The association between psychological factors and self-care in patients with heart failure: an integrative review. Eur J Cardio-vasc Nurs, 22(6):553-561.
13. Liu X, Liu L, Li Y, et al (2023). The associa-tion between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study. BMC Cardiovasc Disord, 23(1):205.
14. Negarandeh R, Aghajanloo A, Seylani K (2021). Barriers to self-care among patients with heart failure: a qualitative study. J Car-ing Sci, 10(4):196-204.
15. Lee CS, Gelow JM, Mudd JO, et al (2015). Profiles of self-care management versus consulting behaviors in adults with heart failure. Eur J Cardiovasc Nurs, 14(1):63-72.
16. Graven LJ, Grant JS, Gordon G (2015). Symptomatology and coping resources predict self-care behaviors in middle to older age patients with heart failure. Nurs Res Pract, 2015:840240.
17. Ferreira JP, Metra M, Mordi I, et al (2019). Heart failure in the outpatient versus inpa-tient setting: findings from the BIOSTAT-CHF study. Eur J Heart Fail, 21(1):112-120.
18. Walsh M, Bowen E, Vaughan C, et al (2023). Heart failure symptom burden in outpa-tient cardiology: observational cohort study. BMJ Support Palliat Care, 13(e3):e1280-e1284.
19. Pobrotyn P, Mazur G, Kałużna-Oleksy M, et al (2021). The level of self-care among patients with chronic heart failure. Healthcare (Basel), 9(9):1179.
20. Girerd N, Mewton N, Tartiere JM, et al (2022). Practical outpatient management of worsening chronic heart failure. Eur J Heart Fail, 24(5):750-761.
21. Taniguchi C, Seto N, Shimizu Y (2021). Outpatient nursing support for self-monitoring in patients with chronic heart failure. PLoS One, 16(7):e0254019.
22. Liljeroos M, Kato NP, van der Wal MHL, et al (2020). Trajectory of self-care behav-iour in patients with heart failure: the im-pact on clinical outcomes and influencing factors. Eur J Cardiovasc Nurs, 19(5):421-432.
23. Schäfer-Keller P, Santos GC, Denhaerynck K, et al (2021). Self-care, symptom experi-ence, needs, and past health-care utiliza-tion in individuals with heart failure: results of a cross-sectional study. Eur J Cardiovasc Nurs, 20(5):464-474.
24. Campbell RT, Willox GP, Jhund PS, et al (2016). Reporting of lost to follow-up and treatment discontinuation in pharma-cotherapy and device trials in chronic heart failure: a systematic review. Circ Heart Fail, 9(5):e002842.
25. Heo S, An M, Kim J (2017). Validation of the symptom status questionnaire-heart failure in Korean patients. Appl Nurs Res, 38:141-146.
26. Kroenke K, Spitzer RL (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann, 32(9):509-515.
27. Hammash MH, Hall LA, Lennie TA, et al (2013). Psychometrics of the PHQ-9 as a measure of depressive symptoms in pa-tients with heart failure. Eur J Cardiovasc Nurs, 12(5):446-53.
28. Shin C, Ko YH, An H, et al (2020). Norma-tive data and psychometric properties of the Patient Health Questionnaire-9 in a na-tionally representative Korean population. BMC Psychiatry, 20(1):194.
29. Han C, Jo SA, Kwak JH, et al (2008). Valida-tion of the patient health questionnaire-9 Korean version in the elderly population: the Ansan geriatric study. Compr Psychiatry, 49(2):218-23.
30. Kim J, Kim KH, Lim YH, et al (2022). Va-lidity and reliability of the Korean version of the revised self-care of heart failure in-dex v7.2. Clin Nurs Res, 31(7):1296-1307
31. Riegel B, Barbaranelli C, Carlson B, et al (2019). Psychometric testing of the revised self-care of heart failure index. J Cardiovasc Nurs, 34(2):183-192.
32. Vellone E, De Maria M, Iovino P, et al (2020). The self-care of heart failure index version 7.2: Further psychometric testing. Res Nurs Health, 43(6):640-650.
33. Charlson M, Wells MT, Ullman R, et al (2014). The Charlson comorbidity index can be used prospectively to identify pa-tients who will incur high future costs. PLoS One, 9(12):e112479.
34. World Medical Association (2013). World Medical Association Declaration of Hel-sinki: ethical principles for medical re-search involving human subjects. JAMA, 310(20):2191-4.
35. Yu S, Lee H (2024). Mediating effects of depressive symptoms and uncertainty on physical symptoms and self-care in Kore-an older men with heart failure. J Nurs Res, 32(6):e364.
36. Azad N, Lemay G (2014). Management of chronic heart failure in the older popula-tion. J Geriatr Cardiol, 11(4):329-37.
37. Heidenreich PA, Bozkurt B, Aguilar D, et al (2022). 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A re-port of the American College of Cardiolo-gy/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
38. McDonagh TA, Metra M, et al (2022). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart fail-ure. Eur J Heart Fail, 24(1):4-131. doi:10.1002/ejhf.2333
39. Riegel B (n.d.). Self-care of heart failure index – Patient version. Available from: https://self-care-measures.com/project/patient-version-schfi-english-v7-2/ (Accessed Aug 14, 2024)
40. Lee KS, Choi JO, Jeon ES, et al (2019). Dis-tinct factors associated with better self-care in heart failure patients with and without mild cognitive impairment. J Cardiovasc Nurs, 34(6):440-447.
41. Aghajanloo A, Negarandeh R, Janani L, et al (2021). Self-care status in patients with heart failure: Systematic review and meta-analysis. Nurs Open, 8(5):2235-2248.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19581 | |
| Keywords | ||
| Assessment Heart failure Depression Symptoms Self-care | ||
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How to Cite
1.
Kim J, Yang J, Cho K, Baek S, Heo S. Effects of a Periodic Assessment of Heart Failure and Depressive Symptoms on Self-Care in Outpatients with Heart Failure: A Randomized Controlled Trial. Iran J Public Health. 2025;54(8):1721-1730.
