Sex-related differences in self-efficacy in patients with heart failure: a pooled cross-sectional study of the German Competence Network Heart Failure.

Aims: To assess the level of self-efficacy in patients with heart failure (HF), identify differences between important subgroups including sex, and identify the determinants of high self-efficacy.
Methods and Results: This was a pooled cross-sectional analysis of 2030 patients from 4 prospective studies conducted within the German Competence Network Heart Failure. We used the self-efficacy subscale and the overall summary score (OSS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) to assess self-efficacy and health-related quality of life. The cut-off of 75 score points was used for the dichotomization into high (≥75) vs. low (<75) self-efficacy. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). A total of 1615 patients with HF provided complete self-efficacy scores: mean age 66.6 ± 12.3 years and 431 (27%) women. The mean self-efficacy score was 67.5 ± 24.9, with 907 patients (56.2%) showing high self-efficacy and 708 patients (43.8%) showing low self-efficacy. Men had higher self-efficacy scores than women (68.7 ± 24.5 vs. 64.2 ± 26.0; P = 0.001). Multivariable logistic regression identified the KCCQ-OSS [odds ratio (OR) per five-point increase 1.08, 95% confidence interval (CI) 1.04-1.12], female sex (OR 0.72, 95% CI 0.56-0.94), depressive symptoms (OR per three-point increase in PHQ-9 0.90, 95% CI 0.83-0.98), and acute HF (OR 0.46, 95% CI 0.34-0.62) as important predictors of high self-efficacy.
Conclusion: In patients with HF, women seemed to exhibit lower self-efficacy than men. Health-related quality of life and psychological well-being were dominant determinants of self-efficacy. Future studies should investigate the role of self-efficacy as a therapeutic target for tailored and sex-specific nursing interventions.
Competing Interests: Conflict of interest: F.K. received travel support from Novartis and Lilly and research support from Novartis and Bayer. F.S., G.G., B.G., H.-C.F., and F.P.-K. have nothing to disclose. J.A. was supported by a clinician scientist scholarship of the Interdisciplinary Center for Clinical Science at the University of Würzburg. M.B. received travel support from Lilly. C.M. received a research cooperation between the University of Würzburg and Tomtec Imaging Systems (funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany) and speakers and consulting honoraria as well as travel grants from Tomtec, Alnylam, Pfizer, Boehringer Ingelheim, SOBI, AstraZeneca, NovoNordisk, Alexion, Janssen, and EBR Systems; she is a principal investigator in trials sponsored by Alnylam, Bayer, NovoNordisk, and AstraZeneca. S.F. was supported by the Deutsche Forschungsgemeinschaft (DFG) and received consultancy and lecture fees as well as support/travel grants for meetings from Abbot, Abiomed, Amarin, Amgen, AstraZeneca, Bayer, Berlin-Chemie, Biotronik, Boehringer, Bristol-Myers Squibb, Boehringer, Daiichi Sankyo, Edwards, Lilly, Novartis, NovoNordisk, Pfizer, Sanofi-Aventis, Siemens, Vifor, and Zoll. A.S. received honoraria as speaker from AstraZeneca, Bayer, Boehringer Ingelheim, and Novartis. S.K. received honoraria from Boehringer Ingelheim, Novartis, AstraZeneca, and Daiichi Sankyo. T.M.-T. received honoraria from Pfizer. C.E.A. received consulting fees from Novartis, Boehringer Ingelheim, and Abbott, payment or honoraria for lecturing from AstraZeneca, Abbott, Boehringer Ingelheim, Radcliffe Group Ltd, and Roche, and travel support from Boehringer Ingelheim and Roche. S.S. received honoraria as speaker or member of advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, NovoNordisk, Pfizer, Servier, and Vifor and research support from the German Ministry of Education and Research and also the industry: Alnylam, Akcea, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Lilly, MSD, Novartis, NovoNordisk, Pfizer, and Servier.
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