Self-care and composite risk of mortality and hospitalization in a Colombian cohort of patients with de novo heart failure
L Cristancho Zambrano, L Z Rojas, A M Jurado, L E Echeverria, V M HerreraAbstract
Introduction
Heart failure (HF) is a global public health problem with high mortality and hospitalization rates. Although clinical practice guidelines recognize self-care as a fundamental element in its comprehensive management, the scientific evidence regarding its association with clinical outcomes is heterogeneous and primarily derived from developed countries, which limits the generalizability of its findings to contexts such as Latin America. In Colombia, research has focused on instrument validation and cross-sectional studies. Therefore, it is imperative to study this association to guide interventions tailored to our context.
Objective
To evaluate the association of self-care with a composite endpoint of mortality and hospitalization in patients with de novo HF in a Colombian cohort.
Methods
A retrospective cohort study was conducted. Self-care was assessed using the European Heart Failure Self-care Behaviour Scale (EHFScBS), and patients were categorized into low and high self-care levels using a median split (cutoff: 36 points). The primary endpoint was the one-year composite of all-cause mortality and HF-related hospitalization. Cumulative incidence (CI) with 95% confidence intervals (95% CI) was calculated and stratified by self-care level. The association between self-care and the composite outcome was evaluated using an adjusted Cox proportional-hazards model.
Results
A total of 6,748 patients with de novo HF were included (median age: 68 years [IQR: 17 years]; 68.3% male; median LVEF: 35% [IQR: 23%]; 41.8% of ischemic etiology) of which 51.1% had a low self-care level. A total of 498 events were recorded, yielding a CI of 7.4% (95% CI: 6.8–8.0) for the entire cohort: 8.2% (95% CI: 7.3–9.1) among individuals with low self-care compared to 6.6% (95% CI: 5.7–7.5) in those with high self-care (p=0.013). In a multivariate model adjusted for time of self-care measurement, age, education level, area of residence, LVEF, HF etiology, BMI, and frailty, patients with low self-care had a 34% higher risk of the composite outcome than those with high self-care (HR=1.34; 95% CI: 1.09–1.66); p=0.622 for the global test of the proportional-hazards assumption).
Conclusion
Low self-care was associated with a higher risk of major clinical events among patients with de novo HR, underscoring the critical need for early educational interventions and self-care support in this population. Our results also suggest that incorporating standardized self-care assessments into routine clinical practice in Colombia could help identify high-risk patients.Survival estimates