Self-Perceptions of Lifestyle Changes During Covid-19, Adherence to Heart Failure Self-Care Behaviors and Their Association with Heart Failure-Related Quality of Life

Introduction During COVID-19, some adults with HF changed lifestyle behaviors due to sheltering at home, fear of hospitals and non-available food items. Aims We examined lifestyle changes, adherence to HF self-care behaviors and their association with quality of life (QoL). Methods Using a prospective, correlational design, ambulatory adults with HF were surveyed by mail on QoL (via KCCQ), adherence to HF-related self-care behaviors (Self-Care HF Index [SCHFI]), exercise (PACE) and changes in diet and fluid consumption, physical activity and provider communication. Comparisons were assessed using Pearson's chi-square, Fisher's exact tests, or Wilcoxon rank sum tests. QoL scores were described using Pearson's or Spearman's correlations with 95% CIs and/or means (SD). Results Of 908 adults, 54.8% were male, 56.2% were married and mean (SD) age was 74.0 (11.7) years. SCHFI maintenance, symptom perceptions and management standardized mean (SD) scores were 76.0 (14.8), 71.7 (20.3) and 60.8 (20.4), respectively. During COVID-19, 68.9% and 52.4% made healthier food and fluid choices, respectively. Healthier food/fluid changes were associated with higher SCHFI maintenance, management and symptom perception scores (all p<0.001). Of participants, 46.8% increased provider communication, and greater communication was associated with higher SCHFI maintenance scores (p<0.027). Physical activity decreased in 48.9% and increased in 23.6% of patients and was associated with SCHFI maintenance scores (p<0.001). The rate of moderate-vigorous aerobic exercise decreased (from 26.8% to 24.5%) and non-exercising was stagnant (from 32.1% to 32.8%). Exercising at higher levels was associated with greater adherence to SCHFI maintenance behaviors before/during COVID-19 (both p<0.001). Standardized mean (SD) overall KCCQ QoL score at baseline was 67.5 (24.5). Higher SCHFI maintenance scores, PACE exercise, and physical activity levels were associated with higher KCCQ QoL domain and overall scores (all p≤0.001) and SCHFI perception scores were negatively associated with KCCQ overall QOL score, and domain scores for symptom frequency and QoL (all p<0.032). Conclusion During the COVID-19 pandemic, an increase in activity and exercise levels and greater adherence to self-care maintenance behaviors were associated with higher HF-related QOL. Lack of positive association between QoL and SCHFI symptom perception and no association with self-care management behaviors may reflect a lack of self-assessment of symptom presence/changes and failure to change HF self-care behaviors when symptoms emerge or worsen.