Factors Associated with Heart Failure Knowledge and Adherence to Self-Care Behaviors in Hospitalized Patients with Acute Decompensated Heart Failure Based on Data from “the Weak Heart” Educational Program

Figures & data

Table 1 Sociodemographic Characteristic of the Study Group

Variable [Categorical]	Features	N = 259 (%)
Age, years (%)	40–70	193 (74.5%)
	> 70	66 (25.5%)
Gender	Female	61 (23.6%)
	Male	198 (76.4%)
Education	Primary	69 (26.6%)
	Secondary or higher	190 (73.4%)
Place of residence	City	173 (66.8%)
	Rural area	86 (33.2%)
Professional activity	Working	60 (23.2%)
	Retired	199 (76.8%)
Comorbidities	None	66 (15.8%)
	One	104 (24.8%)
	> 1	89 (21.2%)
HF education by HCP	No	194 (74.9%)
	Yes	65 (25.1%)
Marital status	Single	43 (16.6%)
	Married	216 (83.4%)
Hospitalizations	None	73 (28.2%)
	Once in the last year	99 (38.2%)
	> 1 in the last year	87 (33.6%)
Variable [continous]
Duration of the HF [years]	M (SD)	6.71 (8.85)
	Me	2.98
	Min-Max	0–42
	Q1; Q3	0.27; 9.86

Table 2 Cronbach’s Alpha Reliability Coefficients for the Knowledge Test in Each of the Three Measurements, Stratified According to Disease Duration, Number of Hospitalizations, and Prior Education on HF

	Measurement 1		Measurement 2		Measurement 3
Duration of Disease	<1 Year	≥1 Year	<1 Year	≥1 Year	<1 Year	≥1 Year
	0.860	0.844	0.856	0.820	0.835	0.838
Number of hospitalizations	First	>1	First	>1	First	>1
	0.840	0.842	0.860	0.809	0.846	0.837
Prior education	Yes	No	Yes	No	Yes	No
	0.830	0.850	0.695	0.847	0.760	0.856

Table 3 Relationships Between Sociodemographic and Clinical Parameters and the Level of Heart Failure Knowledge and Self-Care Among Patients with Acute Decomposed Heart Failure at Baseline (Ie, Before Any Educational Activities Were Performed)

Variable		Mean Level of HF Knowledge (SD) Max Score 20	P value	Mean Level of Self-Care Behaviors (SD) Max Score 45	P value
Total population		8.25±0.34		25.2±9.5
Age, years	<70	8.38±4.42	0.40	25.9±9.9	0.08
	≥ 70	7.86±4.13		23.5±8.4
Gender	Female	7.79±4.01	0.34	26.5±8.7	0.26
	Male	8.39±4.44		24.9±9.8
Education	Primary	6.90±4.08	0.01	25.7±9.0	0.65
	Secondary or higher	8.74±4.34		25.1±9.8
Place of residence	City	5.33±4.09	0.19	25.2±9.7	0.92
	Rural area	8.72±4.21		25.3±9.3
Professional activity	Working	7.20±4.43	0.03	25.0±10.9	0.78
	Retired	8.57±4.28		25.3±9.1
HF hospitalizations in the last year	None	6.05±3.89	<0.001	27.6±10.9	0.02
	At least one	9.11±4.21		24.3±8.8
Comorbidities^a	None	7.55±4.42	0.13	24.3±10.6	0.39
	At least one	8.49±4.30		25.6±9.2
Prior HF education^b	No	7.52±4.19	<0.001	26.3±9.6	0.003
	Yes	10.4±4.08		22.2±8.9
HF diagnosis	Chronic HF	8.72±4.21	<0.001	24.7±9.2	0.03
	De novo HF	5.33±4.09		28.4±11.0
Marital status	Single	7.37±4.4	0.15	23.7±9.2	0.25
	Married	8.42±4.3		25.6±9.6

Notes: HF knowledge was assessed by the HF knowledge questionnaire: the higher the score, the better. Whereas for the 9-EHFScBS questionnaire: the lower the score, the better the assessed self-care. ^aComorbid diseases, including: chronic obstructive pulmonary disease, diabetes, atrial fibrillation, stroke; ^bHealth education performed by a healthcare professional, including: cardiologist, primary care physician, nurse.

Abbreviations: HF, heart failure; SD, standard deviation.

Table 4 Multivariable Regression Analysis of the Influence of Various Independent Factors on the Level of Heart Failure Knowledge and the Level of Self-Care Behavior (The Baseline Scores Were Used)

Dependent Variable	R2	Independent Variable	B 95% CI	P value
Level of HF knowledge	0.26	Age (≥ 70 vs < 70)	−1.16 −2.33–0.002	0.051
		Gender (male vs female)	0.16 −1.01–1.32	0.79
		Education (secondary/higher vs primary)	1.77 0.68–2.86	0.002
		Place of residence (rural area vs city)	−0.63 −1.65–0.39	0.23
		Professional activity (pension/retirement vs working)	1.03 −0.25–2.30	0.11
		Prior HF hospitalizations (at least one in the previous year vs none)	1.77 0.47–3.08	0.008
		Comorbidities (at least one vs none)	0.54 −0.60–1.69	0.35
		Prior HF education (yes vs no)	1.90 0.76–3.03	0.001
		HF diagnosis (de novo vs chronic HF)	−0.78 −2.56–1.00	0.39
		Marital status (married vs single)	1.01 −0.28–2.31	0.12
Level of self-care behavior	0.09	Age (≥ 70 vs < 70)	−3.14 −5.93–(−0.34)	0.028
		Gender (male vs female)	−1.88 −4.69–0.94	0.19
		Education (secondary/higher vs primary)	−0.74 −3.37–1.90	0.58
		Place of residence (rural area vs city)	−0.41 −2.89–2.06	0.74
		Professional activity (pension/retirement vs working)	2.07 −1.00–5.15	0.19
		Prior HF hospitalizations (at least one in the last year vs none)	−2.55 −5.69–0.59	0.11
		Comorbidities (at least one vs none)	2.04 −0.71–4.81	0.15
		Prior HF education (yes vs no)	−3.29 −6.01–(−0.57)	0.02
		HF diagnosis (de novo vs chronic HF)	2.00 −2.31–6.30	0.36
		Marital status (married vs single)	2.51 −0.61–5.62	0.11

Abbreviation: HF, heart failure.

Table 5 Summary of Scores on the Heart Failure (HF) Knowledge and Self-Care Tests

Score in the HF Knowledge Test
Main Effects		Mean (SD)	Pairwise Comparisons
Measurement time	Before the program (visit 1)	8.053 (0.492)	(1–2) P < 0.001 (1–5) P < 0.001 (2–5) P < 0.001
	After the program (visit 2)	15.791 (0.366)
	3 months after the program (visit 5)	17.634 (0.357)
Prior HF education	No	13.568 (0.418)	ns.
	Yes	14.342 (0.471)
HF duration	<1 year	13.685 (0.786)	ns.
	≥1 year	13.897 (0.275)
Hospitalizations	First one	13.087 (0.370)	P = 0.022
	>1	14.565 (0.522)
Score in the Self-Care Behavior Test
Main effects		Mean (SD)	Pairwise Comparisons
Measurement time	Before the program (visit 1)	29.416 (1.141)	P < 0.001
	3 months after the program (visit 5)	36.202 (1.272)
Prior HF education	No	31.283 (1.191)	P = 0.012
	Yes	35.861 (1.346)
HF duration	<1 year	31.156 (2.242)	ns.
	≥1 year	33.636 (0.785)
Hospitalizations	First one	33.485 (1.052)	ns.
	>1	32.134 (1.490)

Abbreviations: HF, heart failure; ns, not significant; SD, standard deviation.

Figure 1 Self-care behaviors (A) before participation and (B) after participation in the program in patients stratified according to the number of hospitalizations and participation in any educational activities on heart failure (HF).