Christopher S. Lee

S elf-care is advocated as a method of improving outcomes from heart failure (HF), the final common pathway for several prevalent illnesses, including hypertension and coronary artery disease.HF is widespread in aging populations across the world. 1 The burden of HF is manifested in poor quality of life (QOL) 2,3 and early mortality. 4In addition, there are Ͼ3 million ambulatory care and emergency department visits 5 and well over 1 million hospitalizations for HF in the United States annually, 6 which contributes to the exorbitant costs associated with HF.Much of this healthcare utilization is thought to be preventable if patients engage in consistent self-care. 7,8his scientific statement seeks to highlight concepts and evidence important to the understanding and promotion of self-care in persons with HF.Specifically, the document describes what is known about (1) the self-care behaviors required of HF patients, (2) factors that make self-care challenging for patients, (3) interventions that promote selfcare, and (4) the effect of self-care on HF outcomes.The review ends with evidence-based recommendations for clinicians and direction for future research.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

BACKGROUND: The Self-care of Heart Failure Index (SCHFI) is a measure of self-care defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiological stability (maintenance) and the response to symptoms when they occur (management). In the 5 years since the SCHFI was published, we have added items, refined the response format of the maintenance scale and the SCHFI scoring procedure, and modified our advice about how to use the scores. OBJECTIVE: The objective of this article was to update users on these changes. METHODS: In this article, we address 8 specific questions about reliability, item difficulty, frequency of administration, learning effects, social desirability, validity, judgments of self-care adequacy, clinically relevant change, and comparability of the various versions. RESULTS: The addition of items to the self-care maintenance scale did not significantly change the coefficient alpha, providing evidence that the structure of the instrument is more powerful than the individual items. No learning effect is associated with repeated administration. Social desirability is minimal. More evidence is provided of the validity of the SCHFI. A score of 70 or greater can be used as the cut-point to judge self-care adequacy, although evidence is provided that benefit occurs at even lower levels of self-care. A change in a scale score more than one-half of an SD is considered clinically relevant. Because of the standardized scores, results obtained with prior versions can be compared with those from later versions. CONCLUSION: The SCHFI v.6 is ready to be used by investigators. By publication in this format, we are putting the instrument in the public domain; permission is not required to use the SCHFI.