We conducted a study to identify barriers to, and factors promoting, self-care among heart failure (HF) patients with higher or lower levels of knowledge. Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed. Using median splits on the HF Knowledge Scale and the European HF Self-Care Behavior Scale, patients were divided into four groups: (a) low knowledge and good self-care, (b) low knowledge and poor self-care, (c) high knowledge and good self-care, and (d) high knowledge and poor self-care. Characteristics of the groups were compared using ANOVA, Kruskal-Wallis tests, and chi-square tests, followed by pairwise tests with Bonferroni correction. Variables significant in the univariate analyses were evaluated as predictors of self-care using hierarchical multiple linear regression. The potential moderating effect of knowledge was tested with interaction terms. The four groups did not differ in sociodemographics or health literacy scores, but differed in New York Heart Association (NYHA) class, comorbidities, and scores on depression, anxiety, and perceived control. In post hoc pairwise tests, patients with high knowledge and poor self-care tended to have worse NYHA class, greater depression and anxiety, and lower levels of perceived control than others. In the multivariate analysis, knowledge, depressive symptoms, and perceived control were significant predictors of self-care, as was the interaction between knowledge and anxiety. Screening and treatment of depression and anxiety is important in improving self-care among HF patients. HF management programs need to include strategies for increasing patients' perceived control over their heart disease.

Background Factors that affect the impact of caregiving on patients’ family members who provide care to patients with heart failure have not been adequately addressed. In addition, social support and positive aspects of caregiving have received little attention. Objective To identify factors associated with the impact of caregiving. Methods Self-report data were collected from 76 dyads of patients with heart failure and their family caregivers. Clinical data were obtained from medical records. Results A sense of less family support for caregiving was associated with a higher New York Heart Association class of heart failure, being a nonspousal caregiver, lower caregivers’ perceived control, and less social support. More disruption of caregivers’ schedules was associated with higher class of heart failure, more care tasks, and less social support. Greater impact of caregiving on caregivers’ health was related to more recent patient hospitalization, lower caregivers’ perceived control, and less social support. Nonwhite caregivers and caregivers whose family member had fewer emergency department visits felt more positive about caregiving than did other caregivers. Social support had a moderating effect on the relationship between patients’ comorbid conditions and positive aspects of caregiving. Conclusions Caregiving has both positive and negative effects on family caregivers of patients with heart failure. The findings suggest the need for interventions to increase caregivers’ sense of control and social support. Family caregivers may need additional support immediately after patient hospitalizations to minimize the negative impact of caregiving.