Association of heart failure symptoms burden with physical well-being: exploring the roles of self-care and sleep quality using a moderated-mediation analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with heart failure (HF) commonly experience symptom burden. Symptoms such as breathlessness, fatigue, and fluid retention can have an important impact on the patient's daily activities and overall health. Given the evidence of symptoms' negative impact on the quality of life in patients with HF, self-care maintenance is critical. However, there is a paucity of knowledge regards the role played by self-care and the quality of sleep in this population. Purpose To explore the association between HF symptoms burden and quality of life (i.e., physical well-being) and how the association was moderated by levels of self-care maintenance and mediated by sleep quality. Methods This was a secondary analysis of a single-center cross-sectional study conducted in Spain, between February and December 2017. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS), and quality of life was assessed using the physical well-being subscale of the 12-Item Short Form Survey (SF-12). Self-care was assessed using the self-care maintenance subscale of the Self-Care Heart Failure Index (SCHFI) (version 6.2), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A moderated-mediation analysis was conducted to explore the role of self-care as a moderator and sleep quality as a mediator in the association using SPSS PROCESS macro with 5000 bootstrap samples, adjusted for age, sex, Body Mass Index (BMI) and NYHA covariates. Results A total of 178 patients completed the questionnaires. The patients were older (mean age 80, SD ±8,9) with a mean BMI of 29 (SD ± 5,5). About of patients were males (50.6%) and NYHA class 1 or 2 (58.4%). Symptom burden was negatively associated with sleep quality (B = -.104, t(1, 176) = -7.7675, p = <,001), which was positively associated with physical well-being (B = .5664, t(1, 176) = 2.9810, p = .003). The association between symptom burden and physical well-being was moderated by self-care maintenance (interaction value= -.0038, t(1, 176) = -2.0022, p = .047). In the moderated mediation analysis (Figure 1), we found that the direct effect strength of burden symptom on physical well-being was different by the level of self-care maintenance (Johnson-Neyman value= 32.3560, low = 15.1685 high = 84.8315). There was also a significant indirect effect of symptom burden on physical well-being through sleep quality adjusted (B = -.0589, 95% CI [ -.1001, -.0230]). Conclusion Self-care maintenance moderates the association symptom burden and physical well-being, while sleep quality acts as a mediator in the association. Improving quality of life, while empowering self-care, should also consider an evaluation and improving stretegies of sleep quality as it impacts physical quality of life.Moderated-mediation analysis