Self-Care and Pathophysiological Function in Patients with Chronic Heart Failure
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Self-Care and Pathophysiological Function in Patients with Chronic Heart Failure Dionne Kessing 1 & Johan Denollet 1 & Jos Widdershoven 1,2 & Nina Kupper 1
# The Author(s) 2019
Abstract Background Self-care is assumed to benefit physiological function associated with prognosis in patients with chronic HF, but studies examining these relations are lacking. This study aims to prospectively examine the association of self-reported HF selfcare with HF-associated pathophysiological markers, including renal, hematological, and immune function. Method Patients with chronic HF (n = 460, 66.2 ± 9.6 years, 75% men) completed questionnaires and provided blood samples at baseline and 12-month follow-up. Linear mixed models examined random intercept and fixed between- and within-subjects effects of global self-care and the individual self-care behaviors on log-transformed TNF-α, IL-6, and IL-10, the glomerular filtration rate of creatinine (GFRcreat), and hemoglobin (Hb), controlling for sociodemographic and clinical covariates. Results Self-care was independently associated with lower GFRcreat levels (β = − .14, P = .023) and improvement in self-care with a reduction in GFRcreat (β = − .03, P = .042). Individual self-care behaviors were differentially associated with renal, inflammatory, and hematological markers. Regular exercise was associated with level differences in IL-6 (P < .001), and improvement in exercise was associated with increasing GFRcreat (P = .002) and increasing Hb (P = .010). Fluid restriction was associated with lower overall GFRcreat (P = .006), and improvement in fluid restriction was associated with decreasing GFRcreat (P = .014). Low-sodium intake was associated with lower levels of Hb (P = .027), lower TNF-alpha (P = .011), and lower IL-10 (P = .029). Higher levels of medication adherence were associated with reduced pro-inflammatory activation (P < .007). Conclusion Our findings suggest that better global self-care was associated with poorer renal function. Performing self-care behaviors such as regular exercise and medication adherence was associated with improved physiological functioning, while restriction of fluid and sodium, and the associated daily weight monitoring were associated with adverse levels of pathophysiological biomarkers. Keywords Adherence . Self-care . Anemia . Renal function . Inflammation . Heart failure
Abbreviations EHFScB European Heart Failure Self-care Behaviour scale GFRcreat Estimated glomerular filtration rate of creatinine HF Heart failure Hb Hemoglobin IL-6 Interleukin-6
IL-10 LVEF NYHA TNF-α
Interleukin-10 Left ventricular ejection fraction New York Heart Association Tumor necrosis factor alpha
Introduction Prof.dr. Johan Denollet passed away on October 26, 2019 * Nina Kupper [email protected] 1
Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
2
Department of Cardiology, Elisabeth-TweeSteden h
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