Editorial
Self-care for patients with heart failure. A pending subject for the healthcare system, patients and their caregivers
Autocuidado del paciente con insuficiencia cardíaca. Una asignatura pendiente para el sistema sanitario, el paciente y su cuidador
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A pending subject for the healthcare system, patients and their caregivers" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "395" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.A. Rodríguez-Murillo, M. Camafort" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J.A." "apellidos" => "Rodríguez-Murillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Camafort" "email" => array:1 [ 0 => "camafort@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Geriátrica de Agudos, Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Autocuidado del paciente con insuficiencia cardíaca. Una asignatura pendiente para el sistema sanitario, el paciente y su cuidador" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The heart failure (HF) guidelines of various scientific societies<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> recommend interventions that improve self-care, through greater understanding of HF, given that this understanding is necessarily the basis for helping patients acquire self-care skills in HF.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Typically, self-care interventions are those that provide patients with information on at least 2 of the following components: the monitoring of signs and symptoms, training in problem-resolution skills and improving drug treatment compliance, physical activity, appropriate dietary intake and smoking cessation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However, the results of HF self-care promotion programs have shown varying results. This diversity can be attributed to the differing study designs, intervention components, follow-up periods and assessments of results. This diversity is likely due to the fact that HF self-care interventions are complex, diverse and often vaguely described, having different effects on different populations and can be confused in drug regimen trials.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> It has been proposed that specific patient subgroups could benefit more (or might not benefit) from self-care interventions.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">For example, a meta-analysis based on individual data from patients that included data from 20 studies with a total of 5624 patients showed that self-care interventions improved aspects such as the time to hospitalization for HF, all-cause death and HF-related quality of life. However, this result was better in patients younger than 65 years, while mortality was higher for the patients with depression.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Likewise, a recent analysis of the CHART-2 study observed differences between the sexes in terms of the prognostic impact of self-care, with a greater reduction in mortality and re-hospitalization rate for women than for men.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A recent meta-analysis underscored another important issue: there are a number of contextual elements that are typically not considered in these self-care promotion programs but that influence self-care in HF. These factors are the presence of caregivers, their HF education, social support, location of the residence, financial situation, employment status and participation in HF programs.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">One last issue to consider, which has been highlighted in recent publications, is the caregiver's education. A recent meta-analysis of 20 studies (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5624 patients) showed that self-care interventions that are directed only at patients without including their informal caregivers were effective in reducing the hospitalization rate, overall mortality and hospital stay and improving the quality of life during the study. However, these effects were not maintained over time, which could be explained by the fact that these interventions were targeted only at the patient and not at the caregiver, who should also receive the necessary health training in HF.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Recent publications on self-care in HF have highlighted an often-forgotten issue: patients with HF often have difficulties integrating clinicians’ recommendations into their daily life. The publications therefore stress that we should adopt an individual approach that emphasizes the need for patients to develop HF self-care skills.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3,9</span></a> This approach should also be based on the co-creation of contents by the patient, caregiver and healthcare practitioners.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We should therefore first determine our situation and our patients’ level of HF self-care. This issue has been poorly studied in Spain, and we have very little data on the knowledge of HF self-care by patients hospitalized in internal medicine departments in Spain, Thus the importance of the article by Juárez-Vela et al. in this issue.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> The authors published a cross-sectional study that sought to determine the level of self-care in 108 patients with HF hospitalized in an internal medicine department. The authors reported a significantly low level of self-care compared with patients from other countries.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With the results of this study, we see a clear deficit in the self-care of patients with HF. We need a structured program to teach patients and their caregivers, a program in which self-care and treatment compliance are managed effectively. The reference nurse has a primary role in transmitting the information and healthy habits and controlling the process. The patient and caregiver need to understand HF, its symptoms, the warning signs of decompensation and the importance of not consuming salt, controlling fluid intake and performing moderate exercise. The patient must live with a chronic disease that needs to be controlled to prevent decompensations and improve quality of life.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We need to implement a structured program with proper scheduling and educational material adapted to the patient's needs and their level of understanding, with essential information, a simple design, illustrations and easy-to-understand content. The program needs to be multidisciplinary to fully optimize the resources each specialty can offer. Telephone and telematic resources need to be employed to avoid travel and to ensure more direct control over the patient's situation, advising the patient and their family on any issues or difficulties. The program needs to provide emotional support to address the disease and the possible loss of function. The program should include planning for educational sessions to strengthen the information, starting with an initial knowledge test to measure whether this knowledge has been absorbed and put into practice.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> We need to ensure continuity of care through appropriate coordination between systems (e.g., hospitals, primary care, homes) and identifying the resources and social situation of the patient and their family.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Murillo JA, Camafort M. Autocuidado del paciente con insuficiencia cardíaca. Una asignatura pendiente para el sistema sanitario, el paciente y su cuidador. Rev Clin Esp. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.2019.01.010">https://doi.org/10.1016/j.rce.2019.01.010</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group" "etal" => true "autores" => array:6 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" 3 => "H. 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