Research Article: Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients’ point of view

Date Published: February 7, 2019

Publisher: Public Library of Science

Author(s): Mohammed Assen Seid, Ousman Abubeker Abdela, Ejigu Gebeye Zeleke, Amir H. Pakpour.

http://doi.org/10.1371/journal.pone.0211768

Abstract

Nowadays, heart failure (HF) related morbidity and mortality rate is increasing globally. Younger populations happen to be more affected by HF in sub- Saharan African than the western countries. Even though medications, low sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and its exacerbation, poor adherence to these self-care recommendations is contributing to an increased in hospitalization, morbidity, and mortality. Therefore, this study aimed to assess heart failure patients’ adherence to self-care recommendations and its associated factors.

A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017. The participants were selected by systematic random sampling technique. Data were collected through face to face interview and from the patients’ medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients’ adherence level.

Of 310 study participants only 22.3% (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR = 2.34, 95% CI: 1.18–4.62), good level of heart failure knowledge (AOR = 2.49, 95% CI: 1.276–4.856) and free from chronic comorbid diseases (AOR = 2.57, 95% CI: 1.28–5.14).

Overall, heart failure patients’ adherence to self-care recommendations is poor and selective. Being male in gender, had no chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients’ knowledge about heart failure signs, symptoms and its management approaches, to improve the patients’ adherence level.

Partial Text

Heart failure (HF) is an ultimate clinical outcome, resulted from either structural or functional dysfunction of ventricular filling or ejection of blood” [1]. HF is a rapidly growing cardiovascular disorder which affects more than 37.7 million individuals worldwide [2].

A hospital-based cross-sectional study was conducted at Gondar University referral hospital from February to May 2017. The hospital is located in Gondar town, Northwest Ethiopia, 738 kilometers away from Addis Ababa, the capital city of Ethiopia. The hospital has a wide range of health care services for the residents. There are four main departments (internal medicine, pediatrics, surgery, and gynecology) holding the lion–share in health care delivery. The department of internal medicine dedicates once per week follow up service for HF patients in the outpatient department. Based on the patient’s clinical condition and place of residence (rural or urban) the appointment for follow-up is either monthly or every three months.

The results of the current study provide an insight to heart failure patients’ adherence to self-care recommendations. In this study, heart failure patients at Gondar University referral hospital had not been engaging in satisfactory self-care. Only 22.3% (95% CI; 17.4%-26.8%) of heart failure patients had good overall adherence to self-care recommendations. This is relatively comparable to the studies done in Sudan by Al-khader et al (28.95%) and in Ethiopia by Sewagegn et al (17.4%) of patients who had good overall adherence to self-care recommendations [22,27]. However, it is low compared to the study done in Atlanta by Marti et al (35.7%) and in the Netherlands by Van Der Wal et al (48%) of patients had been adherent to their self-care recommendations [25,30].

Heart failure patients’ adherence to self-care recommendation is frighteningly low, and selectively medication adherence and appointment keeping were good. Yet, adherence to low sodium diet, limiting excess fluid intake, doing a steady physical activity and weight monitoring was inadequate. Better adherence is associated with the absence of chronic comorbid diseases, being male in gender, and good level of HF knowledge. These results highlight a major opportunity for further prospective follow–up studies, which have an intervention approach for each self–care recommendations. “Although prior research found that self-reported adherence may be comparable to objectively measured adherence (e.g., from serum)[52], future studies assessing HF patient’s adherence through objective measure are warranted to enhance our understanding in this topic.”

 

Source:

http://doi.org/10.1371/journal.pone.0211768

 

Leave a Reply

Your email address will not be published.