Longitudinal patterns and predictors of self‐care behavior trajectories among Korean patients with heart failure: A 6‐month prospective study

Abstract Purpose This study aimed to identify distinct trajectories of self‐care behaviors over 6 months after hospital discharge in patients with heart failure, including the baseline predictors affecting these trajectories. Design This was a prospective longitudinal observational cohort study with a 6‐month follow‐up. Methods A total of 158 patients with heart failure (mean age = 66.75 years, 62.7% men) were included in this study. Patients' characteristics, including cognitive function, health literacy, and social support were collected as possible baseline predictors of self‐care behavior trajectories using a structured questionnaire and an electronic medical record review. Self‐care behaviors were evaluated using the Korean version of the nine‐item European Heart Failure Self‐care Behavior Scale at baseline, 1, 3, and 6 months after hospital discharge. Latent growth model analysis was conducted to identify the homogeneous subgroups with distinct trajectories of self‐care behaviors. Subsequently, multinomial logistic regression was used to assess whether baseline predictors were associated with these trajectories in patients with heart failure. Results Three distinct self‐care behavior trajectory groups were identified: “low‐decreased” ( n = 33, 20.9%), “middle‐increased” ( n = 93, 58.9%), and “high‐sustained” ( n = 32, 20.2%). The multinomial logistic regression analysis showed that baseline adequate health literacy and positive social support significantly predicted patients' belonging to both the middle‐increased and high‐sustained self‐care behavior trajectory groups compared to the low‐decreased group. Importantly, better cognitive function at baseline was only significantly associated with the high‐sustained self‐care behavior trajectory compared to the low‐decreased trajectory. Conclusion Our study revealed that only one‐fifth of the patients belonged to the high‐sustained self‐care behavior group 6 months after hospital discharge. Strategies aimed at improving cognitive function, health literacy, and social support should be developed to sustain satisfactory self‐care behaviors in patients with heart failure. Further studies with long‐term follow‐ups are required to identify other possible factors, as well as the baseline predictors of this study affecting longitudinal trajectories of self‐care behaviors. Clinical relevance Healthcare providers should recognize and evaluate the distinct patterns of self‐care behaviors over time in patients with heart failure. Importantly, assessing baseline cognitive function, health literacy, and social support before hospital discharge may be necessary to prevent a decline in self‐care behaviors over time.