Self-care as a symptom management strategy in people with heart failure

Authors

DOI:

https://doi.org/10.12957/reuerj.2025.89629

Keywords:

Heart failure, signs and symptoms, self-care, nursing

Abstract

Objective: to evaluate strategies adopted for symptom management in people with heart failure. Method: descriptive, qualitative-quantitative study conducted at a University Hospital in Paraná with individuals diagnosed with heart failure. Data collection instruments included sociodemographic and clinical data, open interviews, and the European Heart Failure Self-Care Behavior Scale, analyzed through content analysis and descriptive statistics. Results: the average score on the European Heart Failure Self-Care Behavior Scale among 81 participants was 32.8 (+6.4). Rest, medication adherence, and rest in case of shortness of breath were the most common self-care behaviors. Five thematic categories emerged: adherence to medical prescriptions and seeking healthcare services; self-medication; rest and waiting for improvement; use of complementary therapies; and healthy habits. Conclusion: the main strategies for symptom management were adherence to medical prescriptions, seeking healthcare services, self-medication, rest and waiting for symptom improvement, use of complementary therapies, and the introduction and maintenance of healthy habits.

Author Biographies

Letícia Katiane Martins, Universidade Federal do Paraná

Nurse. Master’s degree in Nursing. Universidade Federal do Paraná. Curitiba, PR, Brazil.

Nen Nalú Alves das Mercês, Universidade Federal do Paraná

Nurse. PhD in Nursing. Associate Professor in the Postgraduate Program in Nursing at the Universidade Federal do Paraná. Curitiba, PR, Brazil.

Ariana Rodrigues da Silva Carvalho, Universidade Estadual do Oeste do Paraná

Nurse. PhD in Nursing. Associate Professor of the Postgraduate Program in Biosciences and Health at the Universidade Estadual do Oeste do Paraná. Cascavel, PR, Brazil.

Shirley Boller, Universidade Federal do Paraná

Nurse. PhD in Nursing. Assistant Professor at the Universidade Federal do Paraná. Curitiba, PR, Brazil.

Maria de Fátima Mantovani, Universidade Federal do Paraná

Nurse. PhD in Nursing. Associate professor at the Universidade Federal do Paraná. Curitiba, PR, Brazil.

Rafael Castilhos da Silva Padilha, Universidade Estadual do Oeste do Paraná

Nurse. Specialist in Nursing in the Adult Intensive Care Unit. Hospital Universitário do Oeste do Paraná. Cascavel, PR, Brazil.

References

1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021 [cited 2024 Sep 12]; 42(36):3599-726. DOI: https://doi.org/10.1093/eurheartj/ehab368.

2. Nordfonn OK, Morken IM, Bru LE, Larsen AI, Husebo AML. Burden of treatment on patients with chronic heart failure – a cross-sectional study. Heart Lung. 2021 [cited 2024 Sep 12]; 50(3):369-74. DOI: https://doi.org/10.1016/j.hrtlng.2021.02.003.

3. Albuquerque DC, Silva PGMB, Lopes RD, Hoffmann-Filho CR, Nogueira PR, Reis H, et al. Breathe investigators: in-hospital management and long-term clinical outcomes and adherence in patients with acute decompensated heart failure: primary results of the first Brazilian registry of heart failure (Breathe). J Card Fail. 2024 [cited 2025 Jan 10]; 30(5):639-50. DOI: https://doi.org/10.1016/j.cardfail.2023.08.014.

4. Ministério da Saúde (BR), Departamento de Informações do Sistema Único de Saúde (DATASUS). Morbidade hospitalar do SUS. Insuficiência cardíaca. Brasília (DF): Ministério da Saúde; 2023 [cited 2024 Sep 29]. Available from: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/.

5. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. Correction to: 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 [cited 2024 May 03]; 145(18):e1033. DOI: https://doi.org/10.1161/CIR.0000000000001063.

6. Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology, Eur J Prev Cardiol. 2021 [cited 2024 Jan 22]; 28(5):460-95. DOI: https://doi.org/10.1177/2047487320913379.

7. Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DC. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol. 2018 [cited 2024 Nov]; 111(3):436-539. DOI: https://doi.org/10.5935/abc.20180190.

8. Riegel B, Lee CS, Dickson VV, Carlson B. An update on the Self-care of Heart Failure Index. J Cardiovasc Nurs. 2009 [cited Nov 2024]; 24(6):48597. DOI: https://doi.org/10.1097/JCN.0b013e3181b4baa0.

9. Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys, et al. Advancing the science of symptom management. J Adv Nurs. 2001 [cited Fev 2024]; 33(5):668-76. DOI: https://doi.org/10.1046/j.1365-2648.2001.01697.x.

10. Humphreys J, Janson S, Donesky D, Dracup K, Lee KA, Puntillo K, et al. Theory of symptom management. In: Smith MJ, Liehr PR. Middle Range Theory for Nursing. New York: Springer Publishing Company. 2014:286–328.

11. Bender MS, Janson SL, Franck LS, Lee KA. Theory of symptom management. In: Smith MJ, Liehr PR. Middle range theory of nursing. New York: Springer publishing company. 2018 [cited Nov 2023]:147-77. DOI: https://doi.org/10.1891/9780826159922.0008.

12. Larson PJ. A Model for Symptom Management. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. Image J Nurs Sch. 1994; 26(4):272-76.

13. Silva LAGP, Lopes VJ, Mercês NNA. Symptom management theory applied to nursing care: scoping review. Rev Bras Enferm. 2021 [cited Jan 2025]; 74(3):e20201004. DOI: https://doi.org/10.1590/0034-7167-2020-1004

14. Mulugeta H, Sinclair PM, Wilson A. The experience of people living with heart failure in Ethiopia: a qualitative descriptive study. PLoS One. 2024 [cited Jan 2025]; 19(10):e0310600. DOI: https://doi.org/10.1371/journal.pone.0310600.

15. Lin CY, Hammash M, Mudd-Martin G, Biddle MJ, Dignan M, Moser DK. Older and younger patients' perceptions, evaluations, and responses to worsening heart failure symptoms. Heart Lung. 2021 [cited Aug 2024]; 50(5):640-7. DOI: https://doi.org/10.1016/j.hrtlng.2021.05.005.

16. Thida M, Asdornwised U, Thosingha O, Dumavibhat C, Chansatitporn N. Symptom Experience, Symptom management strategies, and health related quality of life among people with heart failure. Pacific Rim Int J Nurs Res. 2021 [cited Feb 2024]; 25(3):359-74. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/243557/170820.

17. Cárdenas CYB, Cuevas VMC, Reyes JR. Experiencia del síntoma en el Síndrome Coronario Agudo: comprobación de un modelo conceptual. Investigación en Enfermería: Imagen y Desarrollo. 2023 [cited Jan 2024]; 25. DOI: https://doi.org/10.11144/Javeriana.ie25.essc.

18. The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed Little, Brown & Co; Boston, Mass: 1994. pp. 253–56.

19. Feijó MK, Ávila CW, Souza EN, Jaarsma T, Rabelo ER. Adaptação transcultural e validação da European Heart Failure Self-care Behavior Scale para o português do Brasil. Rev Latino-Am Enfermagem. 2012 [cited Feb 2024]; 20(5):9. DOI: https://doi.org/10.1590/S0104-11692012000500022.

20. Creswell JW, Creswell JD. Projeto de pesquisa: métodos qualitativo, quantitativo e misto. Porto Alegre: Penso, 2021. 241 p.

21. Leal JSS, Figueiredo LS, Oliveira MBO, Fiore ACM, Flores PVP, Cavalcanti ACD. Autocuidado de pacientes com insuficiência cardíaca em tempos da COVID-19. REAS, 2023 [cited Aug 2024]; 23(8):e12783. DOI: https://doi.org/10.25248/reas.e12783.2023.

22. Silva MAG, Brunori EHFR, Murakami BM, D'Agostino F, Lopes CT, Santos VB, et al. Predictors of self-care behaviors in individuals with heart failure in Brazil. Rev Gaúcha Enferm. 2023 [cited Aug 2024]; 44:e20220357. DOI: https://doi.org/10.1590/1983-1447.2023.20220357.en.

23. Seckin M, Petrie MC, Stewart S, Johnston BM. Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure. BMJ Open. 2024 [cited Jan 2025]; 14(11):e088335. DOI: https://doi.org/10.1136/bmjopen-2024-088335.

24. Espinosa B, Llorens P, Gil V, Rossello X, Jacob J, Herrero P, et al. Prognosis of acute heart failure based on clinical data of congestion. Rev Clin Esp (Barc). 2022 [cited Mar 2024]; 222(6):321-31. DOI: https://doi.org/10.1016/j.rceng.2021.07.004.

25. Ok JS, Choi H. Factors affecting adherence to self-care behaviors among outpatients with heart failure in Korea. Korean J Adult Nurs. 2015 [cited Nov 2023]; 27:242-50. DOI: https://doi.org/10.7469/kjan.2015.27.2.242.

26. Yoshinaga R, Tomita K, Wakayama K, Furuta S, Miyamoto K, Matsuda Y, et al. Factors related to self-care behaviors among hospitalized patients with heart failure in Japan, based on the European Heart Failure Self-Care Behaviour Scale. J Phys Ther Sci; 2022 [cited Feb 2024]; 34(6):416-21. DOI https://doi.org/10.1589/jpts.34.416.

27. Costa FBDS, Gama GGG, Mendes AS. Autocuidado de indivíduos com insuficiência cardíaca. Revista de Enfermagem da UFSM. 2020 [cited Feb 2024]; 10:e46. DOI: https://doi.org/10.5902/2179769240711.

28. Lima JG, Barros ALBL, Lopes JL. Comportamento de autocuidado de pacientes com insuficiência cardíaca: relação com variáveis sociodemográficas e clínicas. Texto Contexto Enferm. 2023 [cited Mar 2024]; 32:e20230191. DOI: https://doi.org/10.1590/1980-265X-TCE-2023-0191pt

29. D'Souza PJJ, George LS, Paramasivam G, Devasia T, George A, Nayak BS, et al. Knowledge and self-care behavior among heart failure patients in South India. J Educ Health Promot. 2024 [cited Jan 2025]; 28(13):384. DOI: https://doi.org/10.4103/jehp.jehp_1956_23.

30. Schäfer-Keller P, Santos GC, Denhaerynck K, Graf D, Vasserot K, Richards DA, et al. Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study. Eur J Cardiovasc Nurs. 2021 [cited Mar 2024]; 20:464–74. DOI: https://doi.org/10.1093/eurjcn/zvaa026.

31. Ingadottir B, Jaarsma T, Norland K, Ketilsdóttir A. Sense of security mediates the relationship between self-care behavior and health status of patients with heart failure: a cross-sectional study. J Cardiovasc Nurs. 2023 [cited Mar 2024]; 38(6):537-45. DOI: https://doi.org/10.1097/JCN.0000000000000981.

32. Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, et al. Burden and quality of life among female and male patients with heart failure in Europe: a real-world cross-sectional study. Patient Prefer Adherence. 2021 [cited Feb 2024]; 15:1693-706. DOI: https://doi.org/10.2147/PPA.S312200.

33. Turrise S, Hadley N, Phillips-Kuhn D, Lutz B, Heo S. A snapshot of patient experience of illness control after a hospital readmission in adults with chronic heart failure. BMC Nurs. 2023 [cited Feb 2024]; 22(75):1-11. DOI: https://doi.org/10.1186/s12912-023-01231-x.

34. Guidotti E, Pennucci F, Valleggi A, Rosis S, Passino C. A longitudinal assessment of chronic care pathways in real-life: self-care and outcomes of chronic heart failure patients in Tuscany. BMC Health Serv Res. 2022 [cited Feb 2024]; 22(1):1146. DOI: https://doi.org/10.1186/s12913-022-08522-0.

35. Reeder KM, Ercole PM, Patrick M, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs. 2015 [cited Feb 2024]; 30(1):E1-7. DOI: https://doi.org/10.1097/JCN.0000000000000117.

36. Sethares KA, Mary-Elizabeth S, Fisher PBA, Riegel B. Factors associated with delay in seeking care for acute decompensated heart failure. J Cardiovasc Nurs. 2014 [cited Feb 2024]; 29(5):429-38. DOI: https://doi.org/10.1097/JCN.0b013e3182a37789.

37. Liu X, Liu L, Li Y, Cao X. The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study. BMC Cardiovascular Disorders. 2023 [cited Aug 2024]; 23. DOI: https://doi.org/10.1186/s12872-023-03247-2.

38. Okada, AMN, Tsuchihashi-Makaya M, Kang, JBS, Aoki, Y, Fukawa MMN, Matsuoka SMS. Symptom perception, evaluation, response to symptom, and delayed care seeking in patients with acute heart failure: an observational study. J Cardiovascular Nurs. 2019 [cited Feb 2024]; 34(1):36-43. DOI: https://doi.org/10.1097/JCN.0000000000000526.

39. Nascimento HR, Puschel VAA. Ações de autocuidado em portadores de insuficiência cardíaca. Acta Paul Enferm. 2013 [cited Feb 2024]; 26(6):601-7. DOI: https://doi.org/10.1590/S0103-21002013000600015.

40. Soares AN, Morgan BS, Santos FBO, Matozinhos FP, Penna CMM. Crenças e práticas de saúde no cotidiano de usuários da rede básica de saúde. Rev enferm UERJ. 2014 [cited Feb 2024]; 22(1):83-8. Available from: https://www.e-publicacoes.uerj.br/enfermagemuerj/article/view/11450/8988

Published

2025-12-17

How to Cite

1.
Martins LK, Mercês NNA das, Carvalho AR da S, Boller S, Mantovani M de F, Padilha RC da S. Self-care as a symptom management strategy in people with heart failure. Rev. enferm. UERJ [Internet]. 2025 Dec. 17 [cited 2026 Apr. 17];33(1):e89629. Available from: https://www.e-publicacoes.uerj.br/enfermagemuerj/article/view/89629

Issue

Section

Research Articles

Most read articles by the same author(s)