Brief report : Patient activation among urban hospitalized patients with heart failure

Background
Patient activation influences patients' ability to meaningfully engage in critical heart failure self-care. The purpose of this study was to identify whether patient activation is associated with patient-reported health outcomes in an urban and racially diverse inpatient sample of patients with heart failure.

Methods
We prospectively recruited patients with heart failure hospitalized at an urban academic medical center from October 2016 to May 2017 and measured patient activation, physical and affective symptoms, physical function, self-care, perceived control, and self-efficacy. Differences in patient-reported health outcomes between low and high activation groups were compared with the use of linear regression models adjusting for age, sex, education, left ventricular ejection fraction, and New York Heart Association functional classification.

Results
A total of 96 patients completed the study (mean age 57 ± 12.4 y); 39% identified as black and 35% as Latino, 35% were female, and 50% reported not having enough income to make ends meet. Based on the 4 levels of activation defined by the Patient Activation Measure–13, 22% of patients reported being “disengaged and overwhelmed,” 14% were “becoming aware, but still struggling,” 39% were “taking action,” and 26% were “maintaining behaviors and pushing further.” Higher patient activation was associated with better applied cognitive abilities, self-care behaviors, perceived control, and self-efficacy.

Conclusion
Patient activation can be easily measured in hospitalized patients with heart failure and is associated with clinically meaningful patient-reported health outcomes.