Biomarkers of myocardial stress and systemic inflammation in patients who engage in heart failure self-care management

Abstract

Background: Self-care is believed to improve heart failure (HF) outcomes, but the mechanisms by which such improvement occurs remain unclear.

Methods: We completed a secondary analysis of cross-sectional data collected on adults with symptomatic HF to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation. Multivariate logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of amino-terminal pro-B-type natriuretic peptide and soluble tumor necrosis factor α receptor type 1 at or greater than the sample median. Heart failure self-care was measured using the Self-care of Heart Failure Index.

Results: The sample (n=168) was predominantly male (65.5%), and most (50.6%) had New York Heart Association III HF (mean left ventricular ejection fraction, 34.9% [SD, 14.0%]); mean age was 58.8 (SD, 11.5) years. Self-care management was an independent factor in the model (block χ=14.74; P=.005) after controlling for pertinent confounders (model χ=52.15; P<.001). Each 1-point increase in self-care management score (range, 15-100) was associated with a 12.7% reduction in the odds of having levels of both biomarkers at or greater than the sample median (adjusted odds ratio, 0.873; 95% confidence interval, 0.77-0.99; P=.03).

Conclusion: Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacological therapy and other common confounding factors. Teaching HF patients early symptom recognition and self-care of symptoms may decrease myocardial stress and systemic inflammation.

Figure 1. The Influence of Self-Care Management on the Adjusted Odds of Having Levels of NT-proBNP and sTNFR1 Above the Sample Median

The relationship between self-care management and levels of biomarkers of myocardial stress and systemic inflammation varied across levels of self-care management. Horizontal dashed line indicates neutral odds; for 69.6% of the sample, better self-care management was associated with lower odds of having levels of both biomarkers above the sample median. For the remaining 30.4% (those with self-care management scores of 70 or above), higher levels of self-care management were associated with increasing trend in the odds of having higher levels of both biomarkers. Results shown are adjusted for the influence of age (sample mean), gender (female), body mass index (sample mean), Charlson comorbidity category (low), left ventricular ejection fraction (sample mean), New York Heart Association functional class (I), non-ischemic etiology, and commonly prescribed heart failure medications.

Figure 2. Two Potential Reasons Why Patients Who Reported the Best Self-Care Had Higher Levels of Biomarkers of Myocardial Stress and Systemic Inflammation

1) Signs and symptoms of HF progression and/or cytokine-induced symptoms may serve as a “wakeup call” and drive patients to engage in better self-care management. 2) Heart failure pathogenesis may be refractory to even the most effective self-care practices (e.g. self-care is not enough), and the intervention of heart failure expert clinicians is what is needed to reduce myocardial stress and systemic inflammation.