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      Adherence to Self-Care Practices and Associated Factors Among Outpatient Adult Heart Failure Patients Attending a Cardiac Center in Addis Ababa, Ethiopia in 2020

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          Proper self-care in patients with chronic illnesses, such as heart failure is allied with the prevention or early detection of health problems and improved clinical outcomes. Even though self-care among patients with heart failure is commonly poor, a low-sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and exacerbation. Poor adherence to these self-care practices contributes to an increase in hospitalization, morbidity, and mortality.


          To assess adherence to self-care practices and associated factors among outpatient adult heart failure patients attending cardiac center in Ethiopia, Addis Ababa, 2020.


          Institution-based cross-sectional study design was used to incorporate 396 heart failure patients who attended the cardiac center in Ethiopia, Addis Ababa. The study was conducted from March to April 2020. Study participants were selected by using a systematic sampling technique. Data were collected through face-to-face interviews and from the patients’ medical records. Epi-data version 3.1 and SPSS version 26 were used for data entry and analysis, respectively. Binary logistic regression analysis was performed to identify predictors of self-care practice. Those variables with p-value <0.25 in the bivariable regression analysis were entered into the multivariable regression analysis and the result were presented using tables, chart, and mean.


          Of 396 respondents, 111 (28%) of patients with heart failure had overall good self-care adherence. Comorbidity (AOR: 1.62; 95% CI: 1.07–2.624), level of knowledge (AOR: 3.58; 95% CI: 2.23–5.79) and depression (AOR: 2.45; 95% CI: 1.048–5.726) were factors significantly associated with adherence to self-care practice.


          Comorbidity, inadequate knowledge, and depression were predictors of self-care practice. As a result, nursing intervention programs regarding knowledge on heart failure are recommended for enhancing self-care practices. Self-care strategies shall target patients with depression and comorbidity.

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          Most cited references 19

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          The PHQ-9

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            2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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              Compliance with non-pharmacological recommendations and outcome in heart failure patients.

              The aim of this prospective study was to investigate the association between compliance with non-pharmacological recommendations (diet, fluid restriction, weighing, exercise) and outcome in patients with heart failure (HF). In total 830 patients after an HF hospitalization participated in the study (age 70 +/- 11; left ventricular ejection fraction 34%). Compliance was measured 1 month after discharge; patients were followed for 18 months. Primary outcomes were the composite of death or HF readmission and the number of unfavourable days. Cox regression analysis was used to determine the association between primary outcome and compliance. Adjustments were made for those variables that were identified as confounders in the association between compliance and outcome. Patients who were non-compliant with at least one of the recommendations had a higher risk of mortality or HF readmission (HR 1.40; P = 0.01). Non-compliance with exercise was associated with an increased risk for mortality or HF readmission (HR 1.48; P < 0.01), while non-compliance with daily weighing was associated with an increased risk of mortality (HR 1.57; P = 0.02). Non-compliance (overall) and non-compliance with exercise were both associated with a higher risk for HF readmission [HR 1.38; P < 0.05(overall) and HR 1.55; P < 0.01(exercise)]. Patients who were overall non-compliant or with weighing and exercise had more unfavourable days than compliant patients. Non-compliance with non-pharmacological recommendations in HF patients is associated with adverse outcome.

                Author and article information

                Patient Prefer Adherence
                Patient Prefer Adherence
                Patient preference and adherence
                15 February 2021
                : 15
                : 317-327
                [1 ]Department of Adult Health Nursing, College of Medicine and Health Sciences, Woldia University , Woldia, Ethiopia
                [2 ]Department of Comprehensive Nursing, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                [3 ]Department of Pediatrics and Child Health Nursing, Wollo University, College of Medicine and Health Sciences , Dessie, Ethiopia
                Author notes
                Correspondence: Mulugeta W/Selassie Gebre Department of Pediatrics and Child Health Nursing, Wollo University, College of Medicine and Health Sciences , P.O. Box 1145, Dessie, EthiopiaTel +251 911954032Fax +251 333115277 Email alzunfa@yahoo.com
                © 2021 Tegegn et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 6, References: 19, Pages: 11
                Funded by: Wollo University;
                The funding process was financially supported by Wollo University.
                Original Research


                self-care, adherence, heart failure


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