Methodological quality of studies assessing validity and reliability of the European Heart Failure Self-care Behaviour Scale : a systematic review using the COSMIN methodology

Aims The European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology. Methods and results To identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality. Conclusion Although the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS

Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan

BACKGROUND: Thirst is a distressing symptom and influences quality of life of patients with heart failure (HF). Knowledge about thirst in HF is insufficient; therefore, the aim of this study was to describe factors related to thirst, self-reported reasons for thirst, and interventions to relieve thirst in 3 different countries. METHODS: A cross-sectional study was conducted in Sweden, the Netherlands, and Japan. Patients were recruited at the HF clinic or during HF hospitalization. Thirst was assessed by a visual analog scale (0-100); reasons for thirst and interventions to relieve thirst were assessed by an open-ended questionnaire. Patients were divided into low and high thirst based on the first and third tertiles of the visual analog scale. RESULTS: Two hundred sixty-nine patients participated in the study (age, 72 ± 12 years). Mean thirst intensity was 24 ± 24, with a mean thirst of 53 ± 15 in the highest tertile. No significant differences in thirst among the 3 countries were found. Multivariable logistic regression analysis showed that a higher dose of loop diuretics (odds ratio, 3.47; 95% confidence interval, 1.49-8.06) and fluid restriction (odds ratio, 2.21; 95% confidence interval, 1.08-4.32) were related to thirst. The most reported reasons for thirst were salty/spicy food (20%) and low fluid intake (18%). Most of the patients (56%) drank more in case of thirst; 20% only drank a little bit, probably related to a fluid restriction. CONCLUSIONS: Thirst in patients with HF was related to a higher dose of loop diuretics and fluid restriction. Healthcare providers should realize that it is important to assess thirst regularly and reconsider the need of a fluid restriction and the amount of loop diuretics in case of thirst

Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale

BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide. AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF. METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency. RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p&lt;0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p&lt;0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable. CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.Funding agencies: Swedish National Science Council [K2013-69X-22302-01-3, 2016-01390]; Swedish National Science Council/Swedish research council for health, working life and welfare (VR-FORTE) [2014-4100]; Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation [E0</p

Validity and reliability of the left ventricular assist device self-care behaviour scale

BackgroundAdequate self-care behaviour is essential for patients with a left ventricular assist device (LVAD) to prevent complications, prolong life, and optimise quality of life. However, there were no valid and reliable measurements available to assess self-care behaviour among patients with LVAD. We have previously developed the 33-item LVAD self-care behaviour scale. ObjectivesTo evaluate psychometric properties of the 33-item LVAD self-care behaviour scale. Methods and resultsData on 127 patients with a LVAD in Israel, Japan, and the USA were analysed (mean age 51 +/- 14.3, 81% male). Exploratory factor analysis extracted three factors, and 13 items were excluded from the scale. Internal consistency assessed by Cronbachs alpha was acceptable for the total scale (alpha = 0.80) and the three subscales: Factor 1: Monitoring (alpha = 0.81), Factor 2: Heart failure self-care (alpha = 0.67), and Factor 3: LVAD self-care (alpha = 0.63). The 20-item version of the LVAD self-care behaviour scale had sufficient convergent validity with another scale that assessed self-care related to the driveline of LVAD (r = 0.47, p&amp;lt;0.001). Test-retest reliability was adequate (intraclass correlation coefficient = 0.58). ConclusionsThe 20-item version of the LVAD self-care behaviour scale showed adequate validity and reliability. The scale is ready for use in clinical practice and research. Additional testing might further optimise the scale.Funding Agencies|Japan Society for the Promotion Science KAKENHI [JP15K20693]</p

How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study

Background: Although the effectiveness of heart failure (HF) disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting. Methods: We developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1: 1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS). Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death. Results: A total of 32 patients were enrolled (mean age, 63 years; 31% female). There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098). During a 2-year follow-up, the HF program was related to better outcomes regarding HF hospitalization and/or cardiac death (14% vs 48%, log-rank test P=0.04). In Cox regression analysis after adjustment for age, sex, and logarithmic of B-type natriuretic peptide, the program was associated with a reduction in HF hospitalization and/or cardiac death (hazard ratio, 0.17; 95% confidence interval, 0.03-0.90; P=0.04). Conclusion: The HF program was likely to increase patients HF knowledge, change their behavior regarding a low-salt diet, and reduce HF hospitalization and/or cardiac events. Further improvement focused on the transition of knowledge to self-care behavior is necessary.Funding Agencies|Japan Society for the Promotion of Science (JSPS) [224943]</p

Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors

Background: Patients self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. Aims: (1) To describe the trajectory of patients self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour. Methods: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of amp;gt; 70 was used to define good self-care behaviour. Results: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p amp;lt; 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p amp;lt; 0.05). Conclusion: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.Funding Agencies|Netherlands Heart Foundation (NHF)Netherlands Heart Foundation [2008B083]</p

The consequences of the COVID-19 pandemic for self-care in patients supported with a left ventricular assist device

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Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure.

AimsImprovement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3&nbsp;months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF.Methods and resultsThis secondary analysis of the HF-Wii study analysed baseline and 3&nbsp;month data of the 6&nbsp;min walk test (6MWT) from 480 patients (mean age 67&nbsp;years, 72% male). Data were analysed separately in patients with a pre-defined 6&nbsp;min walking distance at baseline of &lt;300&nbsp;m (n&nbsp;=&nbsp;79) and ≥300&nbsp;m (n&nbsp;=&nbsp;401). Among patients with a baseline 6MWT of ≥300&nbsp;m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self-reported physical activity [odds ratio (OR)&nbsp;=&nbsp;0.77, 95% confidence interval (CI)&nbsp;=&nbsp;0.60-0.97], lower baseline levels of cognitive function (OR&nbsp;=&nbsp;0.87, 95%CI&nbsp;=&nbsp;0.79-0.96) were significantly associated with lack of improvement in exercise capacity at 3&nbsp;months. Not randomized to exergaming (OR&nbsp;=&nbsp;0.63, 95%CI&nbsp;=&nbsp;0.37-1.09) was likely (P&nbsp;=&nbsp;0.097) to be associated with lack of improvement in exercise capacity at 3&nbsp;months. Among the 79 patients with baseline 6MWT of &lt;300&nbsp;m, 41% (n&nbsp;=&nbsp;32) did not improve 6MWT distance at 3&nbsp;months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR&nbsp;=&nbsp;4.68, 95%CI&nbsp;=&nbsp;1.08-20.35), higher levels of serum creatinine (OR&nbsp;=&nbsp;1.02, 95%CI&nbsp;=&nbsp;1.003-1.03), lower cognitive function (OR&nbsp;=&nbsp;0.86, 95%CI&nbsp;=&nbsp;0.75-0.99), and fewer anxiety symptoms (OR&nbsp;=&nbsp;0.84, 95%CI&nbsp;=&nbsp;0.72-0.98).ConclusionsLower self-reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score &lt;300&nbsp;m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises