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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The heart failure &#40;HF&#41; guidelines of various scientific societies<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> recommend interventions that improve self-care&#44; through greater understanding of HF&#44; given that this understanding is necessarily the basis for helping patients acquire self-care skills in HF&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Typically&#44; self-care interventions are those that provide patients with information on at least 2 of the following components&#58; the monitoring of signs and symptoms&#44; training in problem-resolution skills and improving drug treatment compliance&#44; physical activity&#44; appropriate dietary intake and smoking cessation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; the results of HF self-care promotion programs have shown varying results&#46; This diversity can be attributed to the differing study designs&#44; intervention components&#44; follow-up periods and assessments of results&#46; This diversity is likely due to the fact that HF self-care interventions are complex&#44; diverse and often vaguely described&#44; having different effects on different populations and can be confused in drug regimen trials&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> It has been proposed that specific patient subgroups could benefit more &#40;or might not benefit&#41; from self-care interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">For example&#44; 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&#44; all-cause death and HF-related quality of life&#46; However&#44; this result was better in patients younger than 65 years&#44; while mortality was higher for the patients with depression&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Likewise&#44; a recent analysis of the CHART-2 study observed differences between the sexes in terms of the prognostic impact of self-care&#44; with a greater reduction in mortality and re-hospitalization rate for women than for men&#46;<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&#58; 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&#46; These factors are the presence of caregivers&#44; their HF education&#44; social support&#44; location of the residence&#44; financial situation&#44; employment status and participation in HF programs&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">One last issue to consider&#44; which has been highlighted in recent publications&#44; is the caregiver&#39;s education&#46; A recent meta-analysis of 20 studies &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5624 patients&#41; showed that self-care interventions that are directed only at patients without including their informal caregivers were effective in reducing the hospitalization rate&#44; overall mortality and hospital stay and improving the quality of life during the study&#46; However&#44; these effects were not maintained over time&#44; which could be explained by the fact that these interventions were targeted only at the patient and not at the caregiver&#44; who should also receive the necessary health training in HF&#46;<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&#58; patients with HF often have difficulties integrating clinicians&#8217; recommendations into their daily life&#46; The publications therefore stress that we should adopt an individual approach that emphasizes the need for patients to develop HF self-care skills&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;9</span></a> This approach should also be based on the co-creation of contents by the patient&#44; caregiver and healthcare practitioners&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We should therefore first determine our situation and our patients&#8217; level of HF self-care&#46; This issue has been poorly studied in Spain&#44; and we have very little data on the knowledge of HF self-care by patients hospitalized in internal medicine departments in Spain&#44; Thus the importance of the article by Ju&#225;rez-Vela et al&#46; in this issue&#46;<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&#46; The authors reported a significantly low level of self-care compared with patients from other countries&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">With the results of this study&#44; we see a clear deficit in the self-care of patients with HF&#46; We need a structured program to teach patients and their caregivers&#44; a program in which self-care and treatment compliance are managed effectively&#46; The reference nurse has a primary role in transmitting the information and healthy habits and controlling the process&#46; The patient and caregiver need to understand HF&#44; its symptoms&#44; the warning signs of decompensation and the importance of not consuming salt&#44; controlling fluid intake and performing moderate exercise&#46; The patient must live with a chronic disease that needs to be controlled to prevent decompensations and improve quality of life&#46;<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&#39;s needs and their level of understanding&#44; with essential information&#44; a simple design&#44; illustrations and easy-to-understand content&#46; The program needs to be multidisciplinary to fully optimize the resources each specialty can offer&#46; Telephone and telematic resources need to be employed to avoid travel and to ensure more direct control over the patient&#39;s situation&#44; advising the patient and their family on any issues or difficulties&#46; The program needs to provide emotional support to address the disease and the possible loss of function&#46; The program should include planning for educational sessions to strengthen the information&#44; starting with an initial knowledge test to measure whether this knowledge has been absorbed and put into practice&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> We need to ensure continuity of care through appropriate coordination between systems &#40;e&#46;g&#46;&#44; hospitals&#44; primary care&#44; homes&#41; and identifying the resources and social situation of the patient and their family&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rodr&#237;guez-Murillo JA&#44; Camafort M&#46; Autocuidado del paciente con insuficiencia card&#237;aca&#46; Una asignatura pendiente para el sistema sanitario&#44; el paciente y su cuidador&#46; Rev Clin Esp&#46; 2019&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rce.2019.01.010">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;rce&#46;2019&#46;01&#46;010</span></p>"
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Vol. 219. Issue 7.
Pages 394-395 (October 2019)
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Vol. 219. Issue 7.
Pages 394-395 (October 2019)
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
J.A. Rodríguez-Murilloa, M. Camafortb,
Corresponding author
camafort@clinic.ub.es

Corresponding author.
a Unidad Geriátrica de Agudos, Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
b Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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R. Juárez-Vela, C.M. Sarabia-Cobo, I. Antón-Solanas, E. Vellone, A. Durante, V. Gea-Caballero, J.I. Pérez-Calvo
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