Prevalence of low self-care ability in patients hospitalized with decompensated heart failure

Background

Despite substantial advances in the management of chronic heart failure (HF), inadequate self-care remains a major challenge in routine clinical practice. Assessment of self-care ability may help identify patients who require additional education and support, particularly during hospitalization for decompensated HF.

Purpose

To assess the prevalence of low self-care ability and describe the clinical characteristics of patients hospitalized with decompensated HF.

Methods

This prospective cohort study consecutively included 106 patients hospitalized with symptoms and signs of decompensated HF between December 2024 and June 2025. Self-care ability was assessed using the culturally adapted and validated Kazakh-language version of the European Heart Failure Self-Care Behaviour Scale (EHFScBS-9). A score <23 was defined as high self-care ability. Patients were categorized into two groups: high self-care (score <23, Group 1) and low self-care (score ≥23, Group 2). Demographic, clinical, echocardiographic, and laboratory data were collected at baseline. Follow-up is ongoing, and the present analysis focuses on baseline self-care ability and clinical characteristics.

Results

The median age of the study population was 66.0 (59.0–73.0) years, and 61.3% were male. Ischemic etiology of HF was present in 58.5% of patients. The mean left ventricular ejection fraction was 39.4 ± 7.7%, and 98.1% of patients were in NYHA class III–IV.

The median EHFScBS-9 score was 27.5 (IQR 19.0;33.0). Forty patients (37.7%) demonstrated high self-care ability, whereas 66 patients (62.3%) were classified as having low self-care ability. Patients with low self-care ability had significantly higher NT-proBNP levels (p=0.022) and poorer quality of life assessed by the Kansas City Cardiomyopathy Questionnaire compared with those with high self-care ability (p < 0.001). Low self-care was also associated with lower medication adherence (p < 0.001) and less frequent use of guideline-recommended HF therapies, including beta-blockers (p=0.015), SGLT2 inhibitors (p=0.025), and statins (0.049). Baseline characteristics of patients stratified by self-care ability are presented in Table 1.

Conclusion

Low self-care ability is highly prevalent among patients hospitalized with decompensated HF. Routine assessment of self-care status using a culturally adapted tool during hospitalization may help identify vulnerable patients with more severe disease, poorer quality of life, and lower adherence to guideline-recommended therapy, who could benefit from structured educational programs and closer post-discharge support.For image description, please refer to the figure legend and surrounding text.