Clinical Investigation
A Qualitative Meta-Analysis of Heart Failure Self-Care Practices Among Individuals With Multiple Comorbid Conditions

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Abstract

Background

Most heart failure (HF) patients have other comorbid conditions. HF self-care requires medication and diet adherence, daily weight monitoring, and a thoughtful response to symptoms when they occur. Self-care is complicated when other chronic conditions have additional self-care requirements. The purpose of this study is to explore how comorbidity influences HF self-care.

Methods

Using qualitative descriptive meta-analysis techniques, transcripts from 3 mixed methods studies (n = 99) were reexamined to yield themes about perceptions about HF and self-care and to explore the influence on HF self-care. The Charlson Comorbidity Index identified comorbid conditions.

Results

The sample was 74% Caucasian, 66% male (mean age of 59.6 years ± 15 years). Fifty-three percent of the sample was New York Heart Association Class III. All had at least 1 other chronic condition. Narrative accounts revealed that adherence to diet, symptom monitoring, and differentiating symptoms from multiple conditions were the most challenging self-care skills. Emerging themes included 1) attitudes drive self-care prioritization and 2) fragmented self-care instruction leads to poor self-care integration and self-care skill deficits.

Conclusions

Individuals with multiple chronic conditions are vulnerable to poor self-care. Research testing coaching interventions that integrate self-care requirements and focus on developing skill in self-care across multiple chronic conditions is needed.

Section snippets

Methods

Using qualitative descriptive meta-analysis techniques, transcripts from 3 of our prior mixed methods studies10, 13, 14 in a sample of patients with HF with at least 1 comorbid condition (n = 99) were reexamined to yield themes about perceptions and attitudes about HF and HF self-care and to explore the influence of multiple chronic conditions on HF self-care. Descriptive meta-analysis is a qualitative technique that synthesizes qualitative research findings and ultimately draws on a richer

Results

The sample was 74% Caucasian, 66% male with a mean age of 59.6 years (±15 years). Slightly more than half of the sample (53%) was New York Heart Association Class III (Table 1). All of the subjects had at least 1 comorbid illness. Seventy-nine percent reported 2 or more chronic conditions in addition to HF; 51% reported 3 or more. More than half of the sample (52%) reported a prior myocardial infarction and 25% had experienced a stroke. Diabetes was the most commonly reported noncardiovascular

Discussion

Our study provides unique insight into the daily experiences faced by patients with HF and a comorbid condition. To our knowledge, our finding that individuals prioritize 1 chronic condition over another is a unique contribution to the HF literature. Furthermore, these results suggest that individuals with HF plus multiple chronic conditions are vulnerable to poor self-care because they may perceive HF self-care as a low priority and often lack sufficient skill to adequately practice self-care

Limitations

This descriptive qualitative meta-analysis has a robust sample size of 99, but generalizability of our results is limited because of sample homogeneity. Despite efforts in each of the 3 original studies to recruit a diverse sample based on sociodemographic and illness characteristics, the final sample was predominately Caucasian and male. In this meta-analysis of the combined samples, there was good variability in age, illness characteristics, length of time with HF, and self-care practices

Conclusions

The results of this qualitative meta-analysis suggest that individuals with multiple chronic conditions are vulnerable to poor self-care because of difficulties prioritizing and integrating multiple protocols. Adherence to a low-salt diet, symptom monitoring, and differentiating symptoms of HF from other chronic conditions are particularly challenging in this growing population. Difficulty integrating self-care of diseases and fragmented instructions regarding those conditions from multiple

Disclosures

None.

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