Symptom burden mediates the link between self-reported interoceptive accuracy and self-care in chronic heart failure: a CSM-based cross-sectional study

Effective chronic heart failure (CHF) management critically depends on patients’ self-care (maintenance, symptom perception and management).1 Successful self-care begins with the perceived ability to accurately perceive internal bodily signals; when assessed by self-report, this construct is referred to as self-reported interoceptive accuracy (i.e. perceived interoceptive accuracy).2 Guided by the Common-Sense Model of Self-Regulation (CSM),3 self-reported interoceptive accuracy helps transform raw somatic signals into symptom representations, while cumulative distress constitutes symptom burden that guides self-care actions. Although impaired interoception may amplify negative symptom appraisals, direct mediation testing of symptom burden in the self-reported interoceptive accuracy-self-care link remains lacking in CHF. Therefore, this study used the Interoceptive Accuracy Scale (IAS), a self-report instrument measuring perceived interoceptive accuracy, and tested whether symptom burden mediates the relationship between self-reported interoceptive accuracy and self-care dimensions. This cross-sectional study enrolled 353 CHF patients from the Department of Cardiology, First Affiliated Hospital of Soochow University (February–October 2025; Ethics Approval No. 2025-592). Inclusion: age ≥ 18 years, CHF diagnosis per guidelines,4 NYHA class II-IV, and informed consent. The investigation conforms with the principles outlined in the Declaration of Helsinki. Sample size was estimated via Monte Carlo simulation for SEM (power = 0.80, α = 0.05), indicating a minimum required sample of 262; our final sample exceeded this.