Trajectories and Predictors of the Care Needs of Patients With Chronic Heart Failure: Growth Mixture Modeling

BACKGROUND: Research on the care needs of patients with heart failure (HF) has predominantly relied on cross-sectional studies. Consequently, there is limited understanding of how care needs evolve over time within this population. OBJECTIVES: The aims of this study were to explore the trajectories of care needs in patients with HF 1 year after discharge and analyze the potential factors that can predict these trajectories. METHODS: A total of 197 patients with HF were recruited and followed at 1, 3, 6, and 12 months postdischarge. Care needs were assessed using the care needs survey questionnaire, and potential factors were selected based on the Andersen Behavioral Model. A growth mixture model was used to identify the trajectories of care needs, whereas logistic regression analyses were used for statistical comparisons. RESULTS: Three trajectories in the care needs of patients with HF were identified: (1) a mild increase trajectory, (2) a decline trajectory, and (3) a persistently high trajectory. Need factors were the most significant determinants of care needs trajectories, with higher New York Heart Association functional classification, left ventricular ejection fraction less than 40%, and lower self-reported health serving as key predictors of persistently high trajectory. In contrast, only lower self-efficacy and the absence of a spouse as predisposing factors were associated with an increased risk of maintaining persistently high levels of care needs. CONCLUSION: Care needs after discharge in patients with HF can be characterized by 3 trajectories. Need factors will help clinicians with early identification of patients with persistently high level of care needs.