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Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis

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Abstract

Purpose

Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients’ characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories.

Method

We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association.

Results

Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated.

Conclusion

Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.

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Funding

The study was supported by the National Heart, Lung, and Blood Institute (RO1 HL084394-01A1) and the VISN 4 Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center.

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Authors and Affiliations

  1. Department of Psychology, Università degli Studi di Milano – Bicocca, Milan, Italy

    Luca Pancani & Andrea Greco

  2. Department of Medicine and Surgery, Università degli Studi di Milano – Bicocca, Monza, Italy

    Davide Ausili

  3. Department of Biomedicine and Prevention, Università di Roma “Tor Vergata”, Rome, Italy

    Ercole Vellone

  4. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Barbara Riegel

Authors
  1. Luca Pancani
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  2. Davide Ausili
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  3. Andrea Greco
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  4. Ercole Vellone
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  5. Barbara Riegel
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Corresponding author

Correspondence to Luca Pancani.

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Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pancani, L., Ausili, D., Greco, A. et al. Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis. Int.J. Behav. Med. 25, 399–409 (2018). https://doi.org/10.1007/s12529-018-9731-2

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