Self-care behaviour in terms of compliance and delay of patients with heart failure

PhD ceremony: Mr. M.M.W. Nieuwenhuis, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Self-care behaviour in terms of compliance and delay of patients with heart failure

Promotor(s): prof. D.J. van Veldhuisen, prof. T. Jaarsma

Faculty: Medical Sciences

Both noncompliance with medication and lifestyle recommendations (i.e. a sodium-restricted diet, fluid restriction, daily weighing to assess fluid retention, and exercise), and delay in seeking care in case of worsening symptoms, have negative effects on outcomes in patients with heart failure (HF). The aim of this study was to obtain more insight in the behavior of HF patients regarding compliance and care seeking. To this end, data from the Coordinating study evaluating Outcomes on Advising and Counselling in Heart failure (COACH-study) were used. The complexity of the regimen was an important factor associated with compliance of medication, diet, and fluid restriction. Long-term compliance with daily weighing and exercise was lower than compliance with diet and fluid restriction. Knowledge about HF and education increased compliance with diet and weighing, but not with exercise. Physical limitations due to older age, comorbidity, and motivation (to enjoy exercise or to realise its importance) were important factors influencing compliance with exercise. Long delay in seeking care after worsening symptoms is common in HF patients, even in patients who were previously admitted for HF. Patients with a history of a previous life- threatening event (myocardial infarction or stroke) had a shorter delay than patients without such a history. Furthermore, patients with depressive symptoms more often had a longer delay. This study identified several variables and patient characteristics associated with different aspects of self-care behaviour related to compliance and delay. These new insights should be incorporated into tailored education and counselling in order to improve self-care behaviour in HF patients.