Trends in Self-Management among Adults with Heart Failure from 2011 to 2016 Using the National Health and Nutrition Examination Surveys


Introduction: Heart failure (HF) affects patients’ quality of life as it progresses. Given the unpredictability of HF pathways and complex medical treatments, self-management of HF is demanding work for patients and family caregivers. Patients with HF, for instance, have to monitor symptoms, adhere to dietary recommendation (e.g., DASH diet) and medication regimens, and maintain regular physical activities; thus, discovering such characteristics in a scientific way is important. This study aims to shed light on changes in health-related characteristics and to investigate the self-management status of adults with HF. Methods: This study employed three public datasets provided by the National Health and Nutrition Examination Surveys undertaken between 2011 and 2016 at two-year intervals. The original surveys included a set of questions to measure the health and nutritional status of adults and children in the United States. Among the study cohort, 583 adults (ranging in age from 25 to 80) who self-ereported the diagnosis of HF were filtered for this secondary data analysis (n=187 in 2011-2012, n=182 in 2013-2014, n=214 in 2015-2016). The selected variables for this report included as follows: laboratory data measuring physical health status; depression severity using patient health questionnaire (PHQ-9); comorbidities; prescribed medications; dietary intakes; and physical activities. Results: The overall mean of the medications subjects were prescribed was 9.16 (SD=3.14). Figure 1 illustrates the heatmap for the patterns of comorbid disease. In dietary quality, the averages of sodium intake in each wave were 3093.45 (SD=1787.51), 3015.44 (SD=1567.25), and 3143.59 (SD=1629.42). While there were no significant differences (F=30.82, p=0.311), these values were higher than the AHA recommendation for maintaining sodium intake (less than 2,000mg/day). There were significant changes in the consumption of low-density lipoprotein (F=3.46, p=.033) and triglycerides (F=5.70, p =.004). The proportions of HF patients with moderate to severe depression were 17.11%, 21.98%, and 15.89% respectively. Lastly, subjects walked or bicycled approximately four days a week. However, the average minutes of sedentary activity a week ranged from 477.80 (SD=727.82) to 546.43 (SD= 1150.56). Conclusion: Contrary to our expectations, the self-management among HF patients were not improved even if clinical guidelines for HF management had been updated periodically. Findings suggest that strategies and potential resources for improving self-management of HF should be further investigated.

Journal of Cardiac Failure