The Influence of Heart Failure Self-Care Behavior on Cardiac Performance

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DESCRIPTION (provided by applicant): Heart failure (HF), a syndrome that affects more than five million Americans, is associated with disability, increased morbidity, and decreased quality-of-life. Self-care may be one way of controlling fluid retention and endocrine responses to HF that impair cardiac performance and lead to poor patient outcomes. Although self-care is hypothesized to influence cardiac performance, the scientific basis of this claim has not yet been established. We need further evidence that HF patient's day-to-day self-care practices can influence cardiac performance in order to impress on patients the important role that they play in maintaining optimal cardiac performance and in increasing the quality and years of their health. We intend to use bioimpedance cardiography technology and hormone measurement, along with a strategic procedure of head-down tilt to passively and non-invasively challenge the heart's performance to gain insight into this relationship. A cross-sectional study is proposed to examine the relationship between HF self-care measured using subjective and objective measures and the objective measurement of cardiac performance in response to fifteen minutes of a 15¿ head-down tilt positional challenge. The specific aims of this study are to: 1) describe the relationship between HF self-care and baseline cardiac performance, by measuring A) self-care with the Self-Care of Heart Failure Index, the Medical Outcomes Study Specific Adherence Scale, and 24-hour urine sodium levels to assess adherence to a low sodium diet, and B) cardiac performance with blood levels of atrial natriuretic peptide, as an index of atrial distension, and cardiac hemodynamics with bioimpedence cardiography, including thoracic fluid volume index, stroke volume index, and acceleration index, and 2) describe the relationship between HF self-care and dynamic cardiac performance in response to a fifteen minute, 15¿ head-down tilt positional challenge. Measures of HF self-care will be compared to the relative change in measures of cardiac performance in response to body positioning. This research study examines the self-care behaviors of persons with heart failure and how their heart functions at rest and when stressed. This study will help determine if the day-to-day self-care behaviors of heart failure patients can influence how the heart functions.