The Association Between Self Efficacy, Perceived Social Support and Adherence to Treatment in Patients with Heart Failure

Background: Poor adherence to treatment in heart failure patients is associated with frequent hospital readmissions, worsening of symptoms and premature death. Since the progression of heart failure is also affected by the psychological and social aspects of life, identifying psychosocial variables associated with health-promoting behaviors in these patients is essential. Objectives: The aim of this study was to investigate the relationship between cardiac self-efficacy, perceived social support (PSS) and adherence to treatment in patients with heart failure reduced ejection fraction (HFrEF). Methods: Among patients referred to the outpatient heart failure clinic at Rajaie Cardiovascular, Medical and Research Center, a total of 120 patients with a diagnosis of HFrEF (left ventricular ejection fraction ≤ 35%), were consecutively enrolled. They were asked to complete demographic, cardiac self-efficacy, perceived social support (PSS) and adherence to treatment questionnaires. Results: A total of 120 heart failure patients (70% male, 67% with ischemic etiology) were enrolled. Most patients were between 40 - 59 years old. The mean (SD) score of cardiac self-efficacy was 30.6 (2.4), which shows a fair self-efficacy in our study population. The mean (SD) score for PSS was 94.6 (10) which showed more than 75% of heart failure patients have enjoyed high levels of PSS. The mean (SD) scores for the three domains of adherence to treatment were 7.4 (1.5) for diet, 13.2 (2) for physical activity and 10 (1.4) for medications which shows a poor adherence to the diet. Both PSS and adherence to treatment were significantly correlated with NYHA function class. Multivariable logistic regression indicated that cardiac self-efficacy might be a better independent predictor of treatment adherence than PSS in patients with HFrEF. Conclusions: According to the analyzed data of this study, social support, treatment adherence and self-efficacy among all patients with HFrEF were in acceptable levels. However, both patients and their care givers should be more educated in this regard.