Factors Influencing Health Status among Thai Patients with Heart Failure

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Background: Although self care is fundamental to the management of heart failure, its influence on health status has rarely been directly assessed. Investigations to date in this area are conflicting. Moreover, despite the extent of the problem of heart failure in Thailand, there is little systematic investigation of self-care. Aim: To investigate whether health status is predicted by self-care after controlling for age, gender, duration of illness, and New York Heart Association (NYHA) functional class. Method: In this study, 400 patients (52% male; mean age 65±14; 62% NYHA class III-IV) with a confirmed diagnosis of heart failure six hospitals in the southern region of Thailand. Health status was assessed using the Short Form 36 Health Servey (SF–36). Self-care was measured using the Self-Care of Heart Failure Index. Hierarchical multiple regression was used to determine predictors of health status; variables were entered in blocks with age and gender in the first block, duration of illness (transformed into two groups: ≤ 2 months and more than 2 months) and NYHA class in the second, and self-care in the third. Self-care scores were log transformed so that they better approximated a normal distribution. Result: A significant model predicting health status was produced (F=85.115, p < .001). The R² increased significantly with the addition of each block to the final adjusted R² of .513 (p=.001). Gender was not associated with health status (β=−.021, p=.657), but age (β=–0.161, p < .001), duration of illness (β=−.078, p=.04); NYHA class (β=–0.629, p < .001), and self-care (β=0.133, p=.001) were all associated independently with health status. The addition of self-care was associated with a significant increase in the amount of variability explained by the rest of the model. Conclusion: Newly diagnosed patients, older patients, and those with worse functional status may need special attention to improve health status. Improving Thai patients' self-care abilities may be one way to improve health status in patients with heart failure. Key Word: heart failure, self care, health status. ¹Instructor, ²Assist.Prof, Walailak University, School of Nursing, Thailand. ³Prof. and Gill Endowed Chair, University of Kentucky, College of Nursing, USA.