Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships. Purpose: To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups. Methods: In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro. Results: Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]). Conclusion: Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.