Disease knowledge, self-care behaviours and life quality in heart failure: Experience of the Taiwan National Healthcare.
Min-Hiu LIU1, Chao-Hung WANG1, Chii-Ming LEE2, Yu-Yen HUANG1, Wen-Jin CHERNG1
1 Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan,
2 Division of Cardiology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
ABSTRACT
Introduction: Heart failure (HF) is associated with poor health-related quality of life (HRQoL). In Taiwan, the medical resources and health-care insurance program for HF patients differs from those available in the West. This study sought to test whether there is any change in knowledge, self-care behaviour and HRQoL during 1-year of follow-up under the Taiwan national health-care insurance programme and education by cardiologists at an outpatient clinic. Materials and Methods: 141 HF patients with New York Heart Association (NYHA) class II or III were enrolled at the outpatient clinic three months after stabilisation. Questionnaires on knowledge, self-care, and HRQoL were administered at baseline and after one year. At the end of the study, 36 (26%) patients were lost to follow-up leaving 105 patients in the study. Results: Overall, there was improvement in knowledge, self-care, and HRQoL (p<0.0001) of patients with HF (Class II and III combined) after one year of follow up. Subgroup analysis showed that the improvement of HRQoL was significant only in class III patients. Compared to class II patients at baseline, class III patients had poorer knowledge (p=0.03) and HRQoL (p<0.0001), however exhibited significant improvements in knowledge (p=0.02) and HRQoL (p=0.001). Multivariate analysis showed that functional class (p<0.001) and education level (p=0.03) were independent parameters correlated with the improvement in HRQoL. Compared to class II patients, class III patients had better HRQoL at 1-year and this was significantly associated with better self-care (p<0.0001). Conclusion: In patients with stable HF followed under the Taiwan national health-care insurance by cardiologists at an outpatient clinic, HRQoL improved modestly but more significantly in the NYHA class III subgroup. In the future, it should be tested whether the interventions specific for self-care behaviour in class III patients may yield substantial improvement in HRQoL.
Keywords: Cardiac failure, quality of life, disease knowledge, self-care behaviour
Correspondence author: Chao-Hung WANG, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, 222 Mai Chin Road, Keelung, Taiwan
Tel: 886 2 24313131 Ext 3168
E mail: bearty54@gmail.com
Brunei Int Med J. 2011; 7 (5): 269-279