Heart failure self-care in developed and developing countries

Abstract

Background: Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries.

Methods and results: A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance).

Conclusion: Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.

Figure 1

Comparison of Self-Care Adequacy across Developed and Developing Countries Adequacy was defined as a standardized scale score of ≥70 on a 100 point scale. The proportion of each sample scoring within the adequate range on each scale is compared here. These scores are unadjusted for group differences in demographic, clinical, and/or treatment differences. Using Thailand as the comparison group, self-care maintenance was higher in the U.S. and Australian samples (p<.001), management was higher in all three other samples (p<.001), and confidence was higher in the Mexican sample than any others (p<.001).