Self-care among patients with Heart Failure: A Concise Review
Sheeja Sebastian1, Tresa Anto2, Philo Resmi3
1Associate Professor, Jubilee Mission College of Nursing, Thrissur, Kerala, India.
2Vice-Principal and Guide, Jubilee Mission College of Nursing, Thrissur, Kerala, India.
3Vice-Principal and Coguide, Jubilee Mission College of Nursing, Thrissur, Kerala, India.
*Corresponding Author E-mail: sheejasebastianjmcon@gmail.com
ABSTRACT:
Heart failure (HF) is a major global public health concern characterized by progressive structural and functional abnormalities of the heart, leading to symptoms such as dyspnoea, fatigue, and increased jugular venous pressure. It affects approximately 37.7 million people worldwide, with a prevalence of 1–2% among adults and more than 12% among individuals aged over 80 years. Evidence from studies in South India indicates that ischemic heart disease, rheumatic heart disease, and cardiomyopathies are major etiological factors of HF, often accompanied by comorbidities such as diabetes, hypertension, and renal dysfunction. Research also shows that many HF patients demonstrate inadequate knowledge and suboptimal self-care practices despite relatively good medication adherence. Self-care in HF encompasses a range of daily behaviours, including medication adherence, dietary regulation, symptom monitoring, physical activity, and lifestyle modification. Conceptually, self-care is categorized into three interrelated dimensions: self-care maintenance, self-care monitoring, and self-care management. These behaviours help maintain physiological stability, enable early recognition of symptom worsening, and support timely intervention to prevent complications. However, self-care practices are influenced by multiple determinants, including sociodemographic characteristics, health literacy, psychological factors, social support, and environmental conditions. Barriers such as limited knowledge, cognitive impairment, depression, and economic constraints can hinder effective self-management. Enhancing patients’ understanding and engagement in self-care practices is essential for reducing hospitalizations, improving clinical outcomes, and enhancing overall quality of life.
KEYWORDS: Self-care, Heart Failure, Cardiac Diseases, elf acre Management.
NTRODUCTION:
Heart failure (HF) is an important public health problem. Heart failure (HF) is a progressive and unpredictable cardiac condition resulting from structural and functional abnormalities of the heart. It is characterized by a variety of clinical manifestations, including signs such as increased jugular venous pressure and symptoms such as dyspnoea and fatigue1. HF has affected approximately 15 million people in Europe, 6.5 million in the United States, and more than 37.7 million worldwide. The prevalence of heart failure (HF) among adults is estimated to be between 1% and 2%, increasing to more than 12% among individuals aged over 80 years. Self-care plays a crucial role in the management of HF and has a significant impact on clinical outcomes, quality of life, and the utilization of healthcare services.2.
A Study conducted in-hospital and long-term outcome data of HF patients admitted during 2001–2010 in a tertiary-care centre in South India. The most common underlying causes were cardiomyopathies (9.9%), rheumatic heart disease (34.3%), and ischemic heart disease (36.2%). Of the patients, 26.9% had heart failure with decreased ejection fraction (HFrEF), and 33.8% had atrial arrhythmias. Comorbid diseases were prevalent, with 27.4% of the study population having diabetes, 28.6% having hypertension, and 37.4% having renal impairment.3
A study examining knowledge and self-care practices among patients with heart failure admitted to a tertiary care hospital in South India reported that most participants were men (75.0%) with a mean age of 56.1 ± 7.9 years. A large proportion of the patients had comorbid conditions, including hypertension (65%), diabetes mellitus (58.7%), or both (40.6%). The majority of patients had a left ventricular ejection fraction below 30% (60.6%) and were classified as New York Heart Association (NYHA) class II (43.1%). The average scores for knowledge and self-care behaviour were 7.1 ± 2.0 and 45.0 ± 12.4, respectively. More than half of the participants demonstrated poor self-care practices (51.2%), and a considerable majority (88.3%) had inadequate knowledge regarding heart failure. Although medication adherence was relatively high (87.0%), only a small proportion regularly monitored their body weight (3.1%), and about one-third (32.3%) reported engaging in regular physical exercise4.
A Correlational study was conducted to examine the association between self-care practices and health-related quality of life among 100 patients with congestive heart failure in Punjab. The results indicated that 84% of the participants had good self-care confidence. Additionally, 52% of the patients demonstrated good self-care management, while approximately 33% exhibited an average level of self-care maintenance5.
Self-care plays an important role in the treatment of patients with heart failure (HF) and adequately performed self-care at home can contribute to fewer hospitalizations, lower mortality risk and require less emergency care6. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF selfcare include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy7. Healthcare providers need to understand the patient's selfcare status in order to provide appropriate services for these patients. Adequate self-care can help to prevent aggravating the heart failure situation and improve clinical outcomes8.
Concept and Dimensions of Self-care in Heart Failure:
Self-care in HF refers to patients’ daily behaviors and decisions to maintain health and manage symptoms, including medication adherence, low-salt diet, fluid restriction, daily weighing, physical activity, smoking/alcohol reduction, and prompt response to symptom worsening6. Widely used conceptualizations distinguish three interrelated dimensions: self-care maintenance (routine health behaviors and monitoring), self-care monitoring (symptom recognition and response), and self-care Management (self-efficacy for self-care)9.
Table 1: Dimensions of self care in Heartfailure9
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Self care Maintenance: Behaviours used to maintain Physical and mental stability |
Self care monitoring: the process of observing oneself for changes in signs and symptoms |
Self care management: response to signs and symptoms when they occur |
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· Restrict sodium when needed · Restrict fluids when needed · Limit/refrain from Alcohol · Food supplement for nutrional deficiency · Vaccination · Be physically Active · Take medication as prescribed · Maintain Healthy sleep · No smoking · Adapt travel and leisure if needed |
· Shortness of breath · Oedema · Chest pain · Decreased appetite · Fatigue, tiredeness · Cough, wheezing · Thirst · Palpitation · Dizziness · Activity level · Weight · Pulse.blood pressur · Need for support · Nutritional status · Fever, diarrhoea, vomiting · Feeling of depression, low mood |
· Adjust diuretics · Adjust other medications · Adapt Activity level · Adapt diet · Ask for support · Consult Health care professionals |
Self-care maintenance is sustained through ongoing support from family members, the community, and healthcare professionals; in contrast, the absence of such supportive networks significantly impedes an individual’s ability to effectively engage in self-care practices.Self-care monitoring is facilitated by regular follow-up with healthcare professionals and the availability of supportive resources, whereas barriers may arise from negative self-perceptions and maladaptive attitudes toward the illness. Self-care management encompasses adherence to prescribed treatments and recommended care practices; however, it may be impeded by insufficient knowledge about the disease and the financial burden associated with its management.10,11
Components of Self-Care Behaviors:
Self-care practices in heart failure encompass several key behaviors.
Medication Adherence:
Adherence to prescribed medications such as beta-blockers, ACE inhibitors, angiotensin receptor blockers, and diuretics is essential for controlling symptoms and improving survival.
Dietary Management:
Patients are advised to restrict sodium intake and maintain appropriate fluid balance to prevent fluid retention and worsening heart failure.
Symptom Monitoring:
Daily weight monitoring and observation of symptoms enable early detection of fluid overload and disease deterioration.
Physical Activity:
Regular physical activity and participation in cardiac rehabilitation programs can improve exercise tolerance and cardiovascular function.
Lifestyle Modification:
Smoking cessation, weight management, stress reduction, and limiting alcohol intake contribute to improved health outcomes.
Optimsation of sleep: sleep disorders include sleep-disordered breathing (SDB), insomnia, restless leg syndrome, and circadian rhythm disruption. These behaviors collectively support disease stabilization and long-term management of heart failure9.
Determinants and Barriers:
Self-care behavior arises from a complex interaction of sociodemographic, clinical, psychological, social, economic, and environmental factors. Favorable factors include higher education, adequate HF knowledge, health literacy, self-efficacy, supportive family and social networks, insurance/financial resources, and confidence in healthcare providers12,7.
Barriers include low education, poor HF knowledge and health literacy, cognitive impairment, depression, comorbidities, low self-efficacy, negative emotions, limited provider time, unstructured care, and economic constraints12,13. Social support is consistently positively associated with adherence to selfcare.6
CONCLUSION:
Self-care is a key element of managing heart failure, which is essential for enhancing patient outcomes. Effective self-care practices help maintain physiological stability, enable early recognition of disease deterioration, and promote timely responses to prevent potential complications. Although self-care practices are influenced by multiple factors, focused interventions such as patient education, telemonitoring, and multidisciplinary care programs can substantially improve patients’ ability to manage their condition effectively(6). Future research should emphasize the development of culturally sensitive and technology-enabled interventions aimed at enhancing self-care behaviours among patients with heart failure
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Received on 06.03.2026 Revised on 02.04.2026 Accepted on 28.04.2026 Published on 02.05.2026 Available online from May 05, 2026 Int. J. of Advances in Nursing Management. 2026;14(2):124-127. DOI: 10.52711/2454-2652.2026.00026 ©A and V Publications All right reserved
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