The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study

Figures & data

Table 1 Baseline patient characteristics

Characteristics	ICT-guided DMS; n=60	TM+ICT-guided DMS; n=58	p-value
Demographics
Age (years)	69.5±10.4	68.5±12.7	0.94
Male gender	46 (76.7%)	37 (63.8%)	0.126
LVEF, %	28.4±9.1	25.9±10.6	0.155
Clinical variables
NYHA classification
II	15 (25.4%)	16 (28.1%)	0.862
III	36 (61%)	35 (61.4%)
IV	8 (13.6%)	6 (10.5%)
Laboratory tests
NT-pro-BNP (ng/L), median (IQR)	824 (268; 1,596)	1,862 (553; 18,224)	0.268
Questionnaires
MLHFQ_TOT	46.3±25.1	47.2±20.6	0.840
MLHFQ_PHY	23.8±11.9	23.7±10.5	0.899
MLHFQ_EMO	8.1±7.1	8.4±6	0.553
HADs_D	5.8±4.3	5.8±3.9	0.886
HADs_A	6±4.6	5.1±4.2	0.358

Note: Values are presented as mean ± SD.

Abbreviations: ICT-guided DMS, information–and-communication-technology-guided disease management system; TM+ICT-guided DMS, telemonitoring with ICT-guided disease management system; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; NT-pro-BNP, N-terminal pro-brain natriuretic peptide; IQR, interquartile range; MLHFQ_TOT, Minnesota Living with Heart Failure Questionnaire – total scale; MLHFQ_PHY, MLHFQ – physical subscale; MLHFQ_EMO, MLHFQ – emotional subscale; HADs_D, Hospital Anxiety and Depression scale – Depression subscale; HADs_A, HADs – Anxiety subscale.

Figure 1 EHFScBs scores of the two groups at baseline and at 9 months.

Abbreviations: DMS, disease management system; EHFScBs, European Heart Failure Self-care Behaviour scale; ICT, information and communication technology; TM, telemonitoring.

Figure 2 Dynamics of self-care (improved, did not change, and worsened) among the groups and the whole study group.

Abbreviations: DMS, disease management system; EHFScBs, European Heart Failure Self-care Behaviour scale; ICT, information and communication technology; TM, telemonitoring.

Figure 3 Factors associated with worsening of self-care.

Abbreviations: LVEF, left ventricular ejection fraction; MLHFQ, Minnesota Living with Heart Failure Questionnaire; NYHA, New York Heart Association.

Table 2 Factors contributing to the worsening of self-care

Variables	Univariate analysis				Multivariate analysis
	OR	95% CI for OR		p-value	OR	95% CI for OR		p-value
		Lower	Upper			Lower	Upper
NYHA	–	–	–	0.136	–	–	–	0.033
Class II (reference)	–	–	–	–	–	–	–	–
Class III	0.421	0.177	1.000	0.050	0.251	0.089	0.711	0.009
Class IV	0.703	0.197	2.507	0.587	0.362	0.077	1.691	0.196
NT-pro-BNP per 1,000 ng/L	1.002	0.990	1.014	0.730	–	–	–	–
MLHFQ_TOT per 10 points	1.183	0.999	1.402	0.052	–	–	–	–
MLHFQ_PHY per 10 points	1.450	1.013	2.074	0.042	1.760	1.143	2.712	0.010
MLHFQ_EMO per 10 points	1.792	1.006	3.190	0.048	–	–	–	–
Age per 1 year	0.984	0.953	1.017	0.337	–	–	–	–
LVEF per 5%	0.783	0.630	0.972	0.027	0.750	0.587	0.959	0.022
Gender (male)	0.672	0.301	1.499	0.331	–	–	–	–
+TM group	1.879	0.888	3.978	0.099	–	–	–	–
HADs_A per 1 point	0.968	0.888	1.055	0.460	–	–	–	–
HADs_D per 1 point	1.093	0.997	1.199	0.059	–	–	–	–

Note: Bold values represent significant differences.

Abbreviations: HADs_A, Hospital Anxiety and Depression scale – Anxiety subscale; HADs_D, HADs – Depression subscale.; LVEF, left ventricular ejection fraction; MLHFQ_EMO, MLHFQ – emotional subscale; MLHFQ_PHY, MLHFQ – physical subscale; MLHFQ_TOT, Minnesota Living with Heart Failure Questionnaire – total scale; NT-pro-BNP, N-terminal pro-brain natriuretic peptide; NYHA, New York Heart Association; TM group, telemonitoring group

Figure 4 Regression tree showing the variables influencing changes in self-care.

Notes: Inputs in the tree model (n=118) were the following: intervention group, gender, LVEF, smoking, age, MLHFQ – total scale/physical subscale/emotional subscale, EHFScBs, HADs – Total scale, HADs_D, HADs_A, NYHA class, and NT-pro-BNP. Box plots show the distribution of the change in EHFScBs total score between baseline and 9 months. Central lines represents medians, boxes represent the 25th and 75th percentiles, and whiskers extend to the lowest data point within 1.5 IQR of the lower quartile and the highest data point within 1.5 IQR of the upper quartile. Dots represent extreme values.
Abbreviations: EHFScBs_TOT, European Heart Failure Self-care Behaviour scale – total score; HADs_A, Hospital Anxiety and Depression scale – Anxiety subscale; HADs_D, Hospital Anxiety and Depression scale – Depression subscale; IQR, interquartile range; LVEF, left ventricular ejection fraction; MLHFQ, Minnesota Living with HF Questionnaire; NT-pro-BNP, N-terminal pro-brain natriuretic peptide; NYHA, New York Heart Association.

Table 3 Association of depression with worsening of self-care

Variable	Univariate analysis
	OR	95% CI for OR		p-value
		Lower	Upper
EHFScBs_total >28	1.876	0.82	4.25	0.137
EHFScBs ≤17	1.371	0.40	4.76	0.619
17< EHFScBs ≤28	10.22	1.811	57.691	0.008

Abbreviation: EHFScBs, The European Heart Failure Self-care Behaviour Scale.