Knowledge about self-efficacy and outcomes in patients with heart failure and reduced ejection fraction

Yang, M. et al. (2023) Knowledge about self-efficacy and outcomes in patients with heart failure and reduced ejection fraction. European Journal of Heart Failure, (doi: 10.1002/ejhf.2944) (PMID:37369637) (Early Online Publication)

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Background: Although education in self-management is thought to be an important aspect of the care of patients with heart failure, little is known about whether self-rated knowledge of self-management is associated with outcomes. Objectives: To assess the relationship between patient-reported knowledge of self-management and clinical outcomes in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Using individual patient data from 3 recent clinical trials enrolling participants with HFrEF, we examined patient characteristics and clinical outcomes according to responses to the “self-efficacy” questions of the Kansas City Cardiomyopathy Questionnaire (KCCQ). One question quantifies patients' understanding of how to prevent heart failure exacerbations (“prevention” question) and the other how to manage complications when they arise (“response” question). Self-reported answers from patients were pragmatically divided into: poor (do not understand at all, do not understand very well, somewhat understand), fair (mostly understand), and good (completely understand). Cox-proportional hazard models were used to evaluate time-to-first occurrence of each endpoint, and negative binomial regression analysis was performed to compare the composite of total (first and repeat) heart failure hospitalizations and cardiovascular death across the above-defined groups. Results: Of patients (n = 17 629) completing the “prevention” question, 4197 (23.8%), 6897 (39.1%), and 6535 (37.1%) had poor, fair, and good self-rated knowledge, respectively. Of those completing the “response” question (n = 17 637), 4033 (22.9%), 5463 (31.0%), and 8141 (46.2%) patients, respectively, had poor, fair, and good self-rated knowledge. For both questions, patients with “poor” knowledge were older, more often female, and had a worse HF profile but similar treatment. The rates (95%CI) per 100 person-years for the primary composite outcome for “poor”, “moderate” and “good” self-rated knowledge in answer to the “prevention” question were 12.83 (12.11–13.60), 12.08 (11.53–12.65) and 11.55 (11.00–12.12), respectively, and for the “response” question were 12.88 (12.13–13.67), 12.22 (11.60–12.86) and 11.56 (11.07–12.07), respectively. The lower event rates in patients with “good” self-rate knowledge were accounted for by lower rates of cardiovascular (and all-cause) death and not hospitalization for worsening HF. Conclusions: Poor patient-reported “self-efficacy” may be associated with higher rates of mortality. Evaluation of knowledge of “self-efficacy” may provide prognostic information and a guide to which patients may benefit from further education about self-management.

Item Type:Articles
Status:Early Online Publication
Glasgow Author(s) Enlighten ID:Butt, Mr Jawad and Adamson, Dr Carly and Kondo, Dr Toru and Jhund, Professor Pardeep and Yang, Dr Mingming and McMurray, Professor John and Kober, Professor Lars
Authors: Yang, M., Kondo, T., Adamson, C., Butt, J. H., Abraham, W. T., Desai, A. S., Jering, K. S., Køber, L., Kosiborod, M. N., Packer, M., Rouleau, J. L., Solomon, S. D., Vaduganathan, M., Zile, M. R., Jhund, P. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:27 June 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in European Journal of Heart Failure 2023
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217SCMH - Cardiovascular & Metabolic Health