Caregiver contribution to heart failure patient self-care does not increase caregiver burden

Vellone, E. and Durante, A. and Greco, A. and Annoni, Anna Maria and Steca, P. and Alvaro, R. (2018) Caregiver contribution to heart failure patient self-care does not increase caregiver burden. In: EuroHeartCare 2018, 7-9 June 2018, Dublin, Ireland. (Unpublished)

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Background. Heart failure (HF) is a chronic condition that is raising in the European countries for the aging of the population and for the improved treatment of myocardial infarction. HF affects patient outcomes with repeated hospitalizations, poor quality of life and increased mortality rates. Patient self-care, that is the process that HF patients use to maintain the stability of the disease and to respond to symptoms when they occur, can improve HF outcomes, but in several populations, HF patient self-care was found insufficient. Caregiver contribution (CC) to HF patient self-care, which includes CC to self-care maintenance (i.e. recommending the patient to perform activities that maintain HF stable, for example physical activity) and CC to self-care management (i.e., helping the patient to identify and a treat symptoms of exacerbation, for example, calling the provider in case of ankle swelling) was shown to improve patient outcomes but it could be burdensome for caregivers. To our knowledge, no study was conducted to evaluate if CC to HF patient self-care is burdensome for caregivers. Purpose. The aim of this study was to evaluate if CC to HF self-care increases caregiver burden over and above sociodemographic characteristics of caregivers and sociodemographic and clinical characteristics of patients. Methods. We conduct a secondary analysis of a cross-sectional study in which we enrolled 505 caregivers of HF patients in 28 provinces across Italy. Caregivers were defined as those persons inside or outside the family who provided most of the informal care to the HF patients. In data analysis we considered: the Self-Care Maintenance and the Self-care Management scales’ scores of the CC to Self-Care of Heart Failure Index; the Caregiver Burden Inventory scores; caregiver characteristics (i.e., age, gender, employment, education level, living with patient, hours of caregiving per day, social support); and patient characteristics (age, gender, employment, education level, hospitalization for HF in last year, ejection fraction, NYHA class, months of illness, number of taken medications, comorbidities, cognitive impairment, physical and mental quality of life). We used hierarchical regression to evaluate if caregiver Self-Care Maintenance and Self-care Management scales’ scores predicted Caregiver Burden Inventory scores over and above caregiver and patient characteristics. Results. Caregivers were 56.5 (± 14.9) years old on average and were mostly females (52.5%), patients’ spouses or adult children (82.4%). HF patients were 75.9 (± 10.4) years old on average and were mostly males (55.2%), in New York Heart Association functional class I and II (54.5%). The only caregiver predictor of higher caregiver burden was older age; patient predictors of higher caregiver burden were older age, higher education, a fewer number of taken medications, and lower mental quality of life (R2 = 0.25). At the hierarchical regression, CC to Self-Care Maintenance and CC to Self-Care Management Scale scores were not significant predictors of caregiver burden. Conclusions. Some HF caregiver and patient characteristics were predictors of caregiver burden but CC to self-care was not. Since CC to HF self-care improves patient outcomes and is not burdensome for caregivers, providers may consider caregiver education to self-care as a viable option to improve patient outcomes

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