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A story of maladies, misconceptions and mishaps: effective management of heart failure

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  • Horowitz, Carol R.
  • Rein, Stephanie B.
  • Leventhal, Howard

Abstract

Congestive heart failure (CHF) is a common chronic disease with effective therapy, yet interventions to improve outcomes have met with limited success. Though problems in self-management are suspected causes for deterioration, few efforts have been made to understand how self-management could be improved to enhance the lives of affected patients. We conducted semi-structured interviews of 19 patients with CHF treated at an urban United States hospital to elucidate their knowledge and beliefs about CHF and to understand what underlies their self-care routines. A comparison of the themes generated from these interviews with the common-sense model for self-management of illness threats, clarifies how patients' perceptions and understanding of CHF affected their behaviors. Patients had an acute model of CHF. They did not connect chronic symptoms with a chronic disease, CHF, and did not recognize that these symptoms worsened over time from their baseline of moderate, chronic distress, to a severe state that required urgent care. As a consequence, they often did not manage symptoms on a routine basis and did not, therefore, prevent or minimize exacerbations. When they worsened, many patients reported barriers to reaching their physicians and most reported seeking care primarily in an emergency room. These in depth responses elucidate how the interplay between acute and chronic models of a chronic illness effect self-management behaviors. These factors play a previously not understood role in patient's efforts to understand and manage the ever-present but symptomatically variable chronic illness that is CHF. These new concepts illustrate the tools that may be needed to effectively manage this serious and disabling illness, and suggest possible ways to enhance the self-management process and ultimately improve patients' lives.

Suggested Citation

  • Horowitz, Carol R. & Rein, Stephanie B. & Leventhal, Howard, 2004. "A story of maladies, misconceptions and mishaps: effective management of heart failure," Social Science & Medicine, Elsevier, vol. 58(3), pages 631-643, February.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:3:p:631-643
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    Cited by:

    1. Freydberg, Nicole & Strain, Laurel & Tsuyuki, Ross T. & McAlister, Finlay A. & Clark, Alexander M., 2010. ""If he gives in, he will be gone...": The influence of work and place on experiences, reactions and self-care of heart failure in rural Canada," Social Science & Medicine, Elsevier, vol. 70(7), pages 1077-1083, April.
    2. French, DavidP. & Maissi, Esther & Marteau, Theresa M., 2005. "The purpose of attributing cause: beliefs about the causes of myocardial infarction," Social Science & Medicine, Elsevier, vol. 60(7), pages 1411-1421, April.
    3. Carol E. Smith & Julie Koehler & Janice M. Moore & Elizabeth Blanchard & Edward Ellerbeck, 2005. "Testing Videotape Education for Heart Failure," Clinical Nursing Research, , vol. 14(2), pages 191-205, May.
    4. Citlali Calderon & Lorena Carrete & Jorge Vera-Martínez & María Esther Gloria-Quintero & María del Socorro Romero-Figueroa, 2021. "A Social Marketing Intervention to Improve Treatment Adherence in Patients with Type 1 Diabetes," IJERPH, MDPI, vol. 18(7), pages 1-14, March.
    5. Lucinda J. Graven & Joan S. Grant & Glenna Gordon, 2015. "Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure," Nursing Research and Practice, Hindawi, vol. 2015, pages 1-8, November.
    6. Yu‐Huei Lin & Chen‐Liang Tsai & Lee‐Ing Tsao & Chii Jeng, 2019. "Acute exacerbations of chronic obstructive pulmonary disease (COPD) experiences among COPD patients with comorbid gastrooesophageal reflux disease," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1925-1935, May.
    7. Julie MacInnes, 2014. "An exploration of illness representations and treatment beliefs in heart failure," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(9-10), pages 1249-1256, May.

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