Canadian Journal of Cardiology



      Background. Chronic Heart Failure (CHF) impedes health-related quality of life (HRQL). The therapeutic association between goal-directed behaviours that promote self-care and HRQL is well-established. However, it is not clear whether goal-directed behaviours that patients engage in to pursue a sense of “living well” in their weekly routine contribute to their HRQL. Furthermore, the prototypical themes of routine activities for living well have not yet been identified. To that end, we developed an inventory of goal-directed behaviours for “living well”: the EvalUation of goal-diRected behaviOurs to Promote well-beIng and heAlth (EUROIA). This study presents the EUROIA assessment and its potential clinical utility in predicting HRQL.

      Methods and Results

      This investigation was a substudy of the CHF-CePPORT trial. Baseline and 12-month outcomes for the EUROIA, the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) and the Physical Activity Scale for the Elderly (PASE), as well as hospitalization rates or Emergency Department visits. A principal component analysis was conducted to determine the EUROIA subscales. Internal reliability was established using Cronbach’s alpha (α). Multivariable logistic regression analyses examined the EUROAI’s clinical utility through associations between its subscales and clinical indices 12 months (KCCQ-OS and PASE). An exploratory binomial logistic regression analysis tested the association between EUROIA subscales and a composite index of incident hospitalization or ED visit. 117 CHF (median age=60.0 years) patients from the digital intervention arm of the CHF-CePPORT trial were included, 20.5% women and median KCCQ-OS=82.3 (interquartile range=67-93). The four identified subscales of the EUROIA were: Flourishing, Psychosocial Well-Being, Physical Well-Being, and Social Roles and Responsibilities. Internal reliability (α) was 0.76 at baseline and 0.81 at 12 months. Psychosocial (p=0.049) and Physical Well-Being (p=0.004) were significantly associated with 12-month KCCQ-OS scores. Flourishing was significantly associated with 12-month PASE scores (p=0.02). Incident all-cause hospitalization or ED visits were predicted by the Psychosocial (p=0.05) and Physical Well-Being (p=0.04) subscales.


      This proof-of-concept study presents preliminary evidence to suggest that routine goal-directed behaviours that are reported to promote well-being may have therapeutic benefit. Subsequent research is required to establish prototypical categories of these behaviours and to establish their potential for prescriptive use in current health promotion programs.
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