In patients with chronic heart failure, there have been no gender differences in the impact of self behavior on patient-reported outcomes
Authors: Jose-Bazan N , Jimenez-Marrero S , Calero-Molina E , Moliner P , Hidalgo-Quiros E , Garay A , Ruiz-Munoz M , Ramos-Polo R , Enjuanes-Grau C , Yun-Viladomat S , Calvo E , Alcoberro L , Garcimartin P , Ras M , Comin-Colet J 
Published: October 2022

Abstract

Background
Poor self-care behaviour is associated with a higher risk in heart failure (HF). Gender is a determinant of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL) in HF. Female gender is consistently associated with worse QoL. Whether gender may influence the effect of self-care on PROMS is not known.

Purpose
Describe the effect of self-care on QoL according to gender in a real world cohort of HF patients.

Methods
1120 patients with chronic HF were analysed. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between gender and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of global self-care and its dimensions, multivariate linear regressions models to predict QoL were constructed stratified according to gender. All models were adjusted by determinants of HF severity.

Results
Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value&lt;0.0001). Unadjusted MLHFQ scores were consistenly higher in women compared to men (49±23 vs. 43±24; p-value&lt;0.001). In adjusted GLM, female gender (F=4.8; p-value=0.028) and poor global self-care (F=12.6; p-value&lt;0.001) were independent predictors of higher adjusted scores in MLHFQ, indicating worse global QoL. As shown in Figure 1, the interaction term gender by poor self-care was not significantly associated with MLHFQ scores in adjusted GLM (F=0.018; p-value=0.893): the gap between women and men in terms of QoL was observed in both self-care strata and the effect of self care on QoL was observed in both genders. Multivariate linear regresion models (Table 1) stratified according to female gender (panel A) or male gender (panel B) showed that higher scores in the EHFScBS-9 were associated with lower scores in the MLHFQ in women and men. This effect (Table 1) was equally seen in both genders for global QoL and was driven by global self-care, consulting behaviour, and in a lesser extent by autonomy-baseda dherence. The physical dimension of QoL was not affected by self-care in either women or men except for consulting behaviour.

Conclusions
Self-care is an independent predictor of health-related QoL in HF, regardless of the level of disease severity. Global self-care, autonomy-based adherence and consulting behaviour were particularly associated with global QoL and emotional and social dimensions of QoL in women and men. In both genders, the effect of self-care on QoL was driven by its effect on emotional and social dimensions. Provider-based adherence did not influence QoL.

Funding Acknowledgement
Type of funding sources: None.