Combination of depression and poor knowledge regarding heart failure: a strong determinant of self-care behavior in patients with heart failure

Abstract

Purpose: Depression is common in patients with heart failure (HF) and strongly indicates deterioration of symptom due to HF and mortality. Self-care is a key component of HF management aimed at decreasing morbidity and mortality. However, little has been demonstrated regarding the relationship between depression symptoms and self-care behavior in patients with HF. The present study aimed to evaluate the impact of depressive symptoms on self-care behavior in HF patients. Methods: We evaluated HF-related self-care behaviors (The European Heart Failure Self-Care Behavior Scale), depression symptoms (Self-rating Depression Scale; SDS), and HF-related knowledge in a cross-sectional study involving 187 patients with chronic HF recruited from 3 hospitals in Japan. We assessed the sociodemographic (age, gender, and education level), clinical (etiology, risk factors, comorbidities and severity of HF), medication, and device therapy. We used the analyses of covariance and multivariate linear regression to estimate the association between depression symptoms and self-care behaviors. Results: The patients had a mean age of 66.7{+/-}13.9 years and 64.2% were males. Of these, 75 (40.1%) patients had depression symptoms (SDS [≥]50). Patients with depression showed poorer self-care behavior than those without depression (35.04 vs. 32.11, P=0.038). In particular, the patients with depression had significantly poorer self-care behaviors such as self-monitoring of body weight (P=0.041) and fluid management (P=0.002) than those without depression. Multivariate linear regression analysis demonstrated that symptoms of depression ({beta}=0.545, P=0.004), HF knowledge ({beta}= -0.580, P=0.005), occupation ({beta}= -0.499, P<0.001), and hypertension ({beta}=4.044, P=0.009) were independently associated with self-care behavior. Patients with both depression and poor HF knowledge showed significantly lower self-care behavior than others. Conclusions: Patients with depression symptoms and poor HF knowledge were at a higher risk for poor self-care behavior. To improve self-care behavior and eventually improve clinical outcomes, both psychological intervention and intensive patient education should be incorporated into HF management.