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Title: An East-West comparison of self-care barriers in heart failure.
Authors: Lim, Shir Lynn 
Chan, Siew Pang 
Lee, Kim Yee
Ching, Anne
Holden, Richard J
Miller, Karen F
Storrow, Alan B
Lam, Carolyn Sp 
Collins, Sean P
Keywords: Self-care barriers
acute heart failure
geographic differences
heart failure re-hospitalization
Delivery of Health Care
Follow-Up Studies
Heart Failure
Prospective Studies
Self Care
Surveys and Questionnaires
Survival Rate
Issue Date: Oct-2019
Publisher: SAGE Publications
Citation: Lim, Shir Lynn, Chan, Siew Pang, Lee, Kim Yee, Ching, Anne, Holden, Richard J, Miller, Karen F, Storrow, Alan B, Lam, Carolyn Sp, Collins, Sean P (2019-10). An East-West comparison of self-care barriers in heart failure.. Eur Heart J Acute Cardiovasc Care 8 (7) : 615-622. ScholarBank@NUS Repository.
Abstract: BACKGROUND: Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. METHODS: Acute heart failure patients were prospectively assessed with a standardized instrument comprising of 47 distinct self-care barriers. The multi-equation generalized structural equation model was used to evaluate for geographic differences in barriers experienced, and association of barriers with outcomes. RESULTS: Patient-related factors accounted for six out of 10 most prevalent self-care barriers among the 90 patients, with a median number of 11 barriers reported per patient. The Western patients reported a higher level of barriers when compared with their Eastern counterparts (median (interquartile range) 15 (9-24) versus 9 (4-16), p=0.001), after adjusting for demographics and co-morbidities. Many of these differences could be explained by geographic differences between the countries. There was no significant difference identified in all-cause mortality (19.4% versus 10.2%) and heart failure re-hospitalization (41.9% versus 45.8%) at six months between the groups. CONCLUSIONS: Self-care barriers are highly prevalent among acute heart failure patients, and differ substantially between East and West, but were not associated with geographic differences in outcomes.
Source Title: Eur Heart J Acute Cardiovasc Care
ISSN: 20488726
DOI: 10.1177/2048872617744352
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