Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis

Purpose: Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients’ characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories. Method: We conducted a prospective descriptive study of 225 HF patients followed for 6 months with data collected at baseline and 3 and 6 months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association. Results: Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated. Conclusion: Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.