Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis

Background: Self-care is assumed to benefit health outcomes in patients with chronic heart failure (HF), but the evidence is conflicting for health-related quality of life (HRQOL). The aim of this study was to examine the association of (changes in) self-care with HRQOL while adjusting for psychological distress. Methods: In total, 459 patients (mean age = 66.110.5 years, 73% male) with chronic HF completed questionnaires at baseline and at 6, 12 and 18 months of follow-up. Self-care and HF-specific HRQOL were quantified with the European Heart Failure Self-care Behaviour scale and the Minnesota Living with Heart Failure Questionnaire. Results: Using general linear models, multivariable between-subject (estimate=-0.14, p=0.005) and no within-subject effects of self-care were found for better HRQOL over time. Associations between self-care and HRQOL were fully explained by depression (estimate=1.77, p<0.001). Anxiety (estimate=4.49, p<0.001) and Type D personality (estimate=13.3, p<0.001) were associated with poor HRQOL, but only partially accounted for the relationship between self-care and emotional HRQOL. Conclusions: Self-care was prospectively associated with better disease-specific HRQOL in patients with HF, which was fully accounted for by depression, and partially accounted for by anxiety and Type D personality. Changes in self-care within a person did not affect HRQOL. Psychological distress should be considered in future efforts to address self-care and HRQOL.