Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program

<b>Background/Objective:</b> Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the <i>SCR</i>eening <i>in H</i>eart <i>F</i>ailure (<i>SCRinHF</i>), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. <b>Methods:</b><i>SELFMAN-HF</i> is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium-glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (<b><i>SF</i></b>) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. <b>Results:</b> Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for <b><i>SF</i></b> versus <b><i>LF</i></b> patient scores are as follows: "good self-managers", 13 vs. 30 patients (11.1% vs. 25.6%); "average", 46 vs. 21 patients (39.3% vs. 17.9%), "borderline", 20 vs. 31 patients (17.1% vs. 26.5%), and "poor self-managers" (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of <i>SF</i> tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the <b><i>SF</i></b> with the <b><i>LF</i></b> scores for patients who have poor self-management capabilities (38 vs. 35 patients <i>p</i> = 0.01), alongside readmission (31/38 vs. 31/35 <i>p</i> = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 <i>p</i> = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between <b><i>SF</i></b> and <b><i>LF</i></b> scores. <b>Conclusions:</b> Simplifying self-management scoring with an <b><i>SF</i></b> tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of <b><i>SF</i></b> to <b><i>LF</i></b> scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.