This study attempted to explore the factors influencing HF patients’ QoL and the importance of self-management on their QoL. Among HF patients’ various physical, psychological, behavioral, and diagnostic test results, EF and self-management behavior were factors that significantly influenced their QoL.
Previous studies have shown that EF is an important hallmark in HF patients that reflects the disease prognosis and patient outcomes, such as worsening symptoms, hospital readmission, mortality, and QoL [9, 19, 20]. Since HF cannot be ultimately cured, a necessary treatment strategy is to maintain the functional capacity and improve the QoL by continuous lifetime monitoring with the cooperation of healthcare providers and the patients themselves [10, 21]. Regular observation of the echocardiography results is essential to manage HF patients’ treatment goals, as it is a simple and intuitive measurement for the evaluation of EF. Although increased EF can bring satisfaction to healthcare providers and patients, it is not easy to improve. Various medical treatments, such as pharmacological therapy, cardiac revascularization, resynchronization, and ventricular assist devices, have been availed of to improve the HF patient’s EF; however, everyone does not get complete improvement with uniform treatment, so various studies are ongoing to determine the most favorable and optimal treatment [22, 23]. In addition, measuring EF through echocardiography has also been reported to have limitations, such as limited reliability due to inter- and intra-observer variability and poor image quality [24, 25]. Further, the concerns that QoL and the diverse symptoms of HF patients are not always associated with EF, which is a useful but simplistic parameter to assess the complexity of HF, should be considered in clinical practice .
Self-management behavior can be a modifiable factor in improving QoL in HF patients. In the present study, self-management of HF patients was one of the significant factors impacting their QoL. As we further noticed with the prediction model, even in the low EF group, if the self-management behavior score was relatively high, the relative QoL score was also high. It is in line with the results of a recent systematic review that showed evidence that HF patients can improve their QoL by promoting their self-care behaviors . Previous studies suggested that self-management interventions like education, support, and guidance can improve the QoL in HF patients with diverse delivery methods such as face-to-face interaction, telephonic conversation, accessing websites, mobile applications [27–30].
Self-management of HF is the patients’ comprehensive behavior, including maintaining self-care for physical and psychological stability and self-monitoring the possible worsening signs and symptoms . Maintaining self-care includes taking prescribed medications, doing proper and regular physical activity, limiting salt and water uptake, keeping an adequate body weight, and so on. Self-monitoring also includes observing the signs and symptoms related to HF experienced by patients themselves and responding appropriately before advanced outcomes occur [10, 31]. For patients with chronic conditions like HF, self-management represents a critical strategy for improved treatment outcomes that the patient should accept as an aspect of their daily routine for their lifetime rather than a short-term event . Nevertheless, it is an ongoing challenge for healthcare providers and patients to enable self-management behavior and continue to be stable without giving up. Some studies emphasized HF patients’ role in decision-making based on the knowledge and trial and error experience for self-management adherence [33–35]. Additionally, some studies highlighted the role of healthcare providers in improving self-management in HF patients through constant and multifaceted efforts, such as interactive education, teach-back, retraining, and support using diverse and customized delivery methods [27, 28, 36]. Regardless of the patient’s initial low or high EF, efforts to improve the self-management ability of HF patients will both promote their self-care and ultimately contribute to the achievement of the goal of treatment by enhancing the patients’ QoL.
This study has several limitations. First, this was a retrospective study based on a relatively small and convenient sample, which may not represent the population and therefore has poor generalizability. Second, there may be differences in application to other participants since we analyzed using the median value of the QoL. Third, we used the E/E’ as a representative value for cardiac diastolic function in this study. However, diverse parameters, such as left atrial volume index, lateral early diastolic mitral annular velocity, the ratio of early diastolic transmitral flow velocity to late diastolic transmitral flow velocity (E/A), and E-wave deceleration time, can be considered for assessing diastolic function, and the assessment method we used is not applicable to certain populations with arrhythmia, mitral stenosis, mitral regurgitation, or mitral valve prosthesis . In addition to the quantitative variables of EF and E/E’, the qualitative variables of left ventricular systolic dysfunction and diastolic dysfunction should be considered. Future research should be expanded to include an increased number of participants and comprehensive (both quantitative and qualitative) measurement tools of cardiac function to examine the validity of the prediction model in this study. Nevertheless, this study has strength in confirming that self-management is an important factor impacting the QoL in HF patients.