Relationship between dyadic coping and self-management in patients with chronic heart failure

Relationship between dyadic coping and self-management in patients with chronic heart failure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between dyadic coping and self-management in patients with chronic heart failure Yingmei Shi, Zhihong Tang, Jing Wang, Leilei Liu, Donghong Qi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2668085/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and objective Whether the level of self-management with dyadic coping in chronic heart failure (CHF) patients remains unclear. We investigate the longitudinal changes and correlations between dyadic coping and self-management in patients with CHF. Methods In this study, 106 pairs of chronic heart failure patients and spouses treated in the Department of Cardiology of the Hefei First People's Hospital were selected as study subjects between September 2020 and September 2021. The dyadic coping scale and self-management scale were used for the follow-up survey to analyze the changes and correlation between patients' self-management ability and dyadic coping. Results We followed 106 patients (19 patients lost) CHF for one year, whose overall self-management ability showed a significant decreasing trend. Male patients displayed lower self-management ability than that of female patients, especially at 6 months and 12 months of follow-up ( P <0.05). All patients and spouses showed similar decreasing trend in stress communication scores, cooperation scores, and negative coping scores, but the decreasing trend were more pronounced for male patients. There was a significant positive correlation between female patients' self-management ability and dyadic coping was observed at admission, 6 months and 12 months after discharge ( P 0.05), a significant correlation was monitored at 6 months of discharge ( P <0.05). There was a significant positive correlation between self-management ability and dyadic coping of spouses in male patients ( P <0.05). Conclusion Via elevating the dyadic coping level of patients' spouses, especially male spouses, the self-management ability of patients can be improved. The aforementioned findings provide a foundation for the future clinical nursing interventions to improve the life quality of CHF patients. chronic heart failure self-management dyadic coping correlation Introduction Chronic heart failure (CHF) is a clinical syndrome characterized by stagnant blood in the body and/or pulmonary circulation and low cardiac output [1], which is the end stage of various cardiovascular diseases and has become a public health problem [2]. With the increasing aging problem, the number of elderly patients with chronic heart failure is gradually increasing in China. It not only seriously affects the quality of life of patients, but also poses a heavy burden to the family and society [3]. Therefore, how to improve the rehabilitation level of CHF patients, improve the quality of life and reduce the burden on families has emerged as a major concern in clinical research. Adherence to self-management behaviors is an important factor affecting the rehabilitation outcome of CHF patients and is one of the main reasons for relapse in readmission of CHF patients [4]. CHF patients are able to reduce the rate of readmission and the number of readmissions by improving self-management skills [5]. Despite the importance of self-management capacity, it is obscure what factors influence it, and how family support and social factors affect self-management. Dichotomous coping (dyadic coping) refers to a new division of tasks, whereby both partners should work together to perceive stress, and help each other in the stress coping process to maintain marital stability. Studies have found that dyadic coping contributes significantly to recovery from a variety of diseases (e.g., cancer and various chronic diseases) and promotes mutual intimacy of patients and spouses [6,7,8]. The correlation between the level of self-management and dyadic coping in CHF patients has not been reported. Therefore, this study used a longitudinal research method to investigate the correlation and influencing factors between different dyadic coping and self-management in CHF patients with attempt to direct the future clinical nursing interventions. Methods Research Subjects This study is a longitudinal study, and 106 pairs of CHF patients and spouses treated in the Department of Cardiology of the First People's Hospital of Hefei from September 2020 to September 2021 were selected as study subjects. Inclusion criteria: (1) patients hospitalized with confirmed diagnosis of CHF and cardiac function NYHA classification of grade II-III; (2) age: 30 to 75 years old; (3) clear consciousness and stable vital signs; (4) no combined serious diseases of other organ systems; (5) normal cognition, able to understand and cooperate with instructions; (6) informed consent and signed informed consent form. Exclusion criteria: (1) the presence of congenital physical disabilities, deformities and other functional disorders; (2) and a history of serious complications of other systems and psychiatric disorders. (3) presence of significant cognitive impairment or hearing impairment; (4) declaration of unwillingness to participate in this study. Exclusion and detachment criteria: (1) subjects requested to withdraw from the study; (2) poor compliance, resulting in inability to judge the effect or incomplete collection of relevant data were excluded; (3) subjects with serious changes in condition or serious complications during the study period were not suitable for participation in the study, or patients who did not complete the last follow-up were treated as detached. Research Methodology Survey tools General data of all patients were collected, mainly including age, gender, education, occupation, place of residence, marital status, residential status, monthly income level, number of chronic diseases, cardiac function classification, height, weight, and number of heart failure hospitalizations. The self-management ability of patients was assessed using the Heart Failure Self-Management Scale developed by Shi [9] in 2010, which has 4 dimensions: five entries of medication management, three entries of diet management, five entries of psychological and social adjustment management, and seven entries of symptom management (total of 20 entries). The Likert 4-point scale was used to assess patients' self-management level, where <60% was low, 60%-79% was moderate, and ≥80% was high. One point to four point indicated never, sometimes, often, and always, respectively, with a total score of 80 points. The scale was standardized by using the score rate, and the score rate equals the actual score of the scale/the highest score of the scale×100%. The scale had a content validity of 0.98 and a Cronbach's alpha coefficient of 0.78, with good reliability. The German version of the Dyadic Coping Inventory (DCI) [10]was used to assess the dichotomous support coping of all patients and spouses. All items were rated on a 5-point Likert scale (1~5: rarely to very frequent), which has good reliability with content validity of α=0.67 to α=0.87. Data collection All patients were instructed to fill in the above survey instrument at admission, 6 months and 12 months after discharge using the above survey instrument for patients and spouses. For patients who could not fill it out on their own, the investigator used pertinent instructions to explain that future generations would fill it out for them, distributed the recall on site and verified the questionnaire with the patients, and disease-related information was obtained by reviewing the patients' medical records and relevant medical examination reports. To ensure follow-up rate, the study had a separate folder and number for each patient. The investigator left the patient's phone number or WeChat when the patient filled out the questionnaire for the 1 st time, distributed research gifts, and recorded the dates at admission, 6 months, and 12 months after discharge. Contact patients a day in advance to schedule a time to fill out the questionnaire to reduce the rate of missed visits. Statistics All data were double-checked and imported into the database, and SPSS 23.0 software was used for data analysis. The measurement data conformed to normal distribution and were expressed by` x ±s, and t-test was used for comparison of two groups. Repeated measures data were analyzed by repeated measures ANOVA, and paired t-test was used for comparison between groups. Median M ( Q 25 , Q 75 ) was used for non-normally distributed data, and non-parametric statistics was used for comparison between groups. Count data were expressed as n (%), and the chi-square test or Fisher's exact test was used for comparison between groups. Correlation analysis of the correlation between self-management ability, and dyadic coping was performed using Spearman's rank correlation analysis with a two-sided test level α=0.05. Results Comparison of general information of enrolled patients and patients lost to follow-up At admission, all 106 pairs of patients completed the survey study and were discharged at 6 months (94 pairs) and 12 months (87 pairs). At 6 months of discharge, 10 male patients and 2 female patients were lost, and at 12 months of discharge, 6 male patients and 1 female patient were lost. The majority of the lost patients were male, elementary school educated, farmers, rural residents. The number of chronic diseases (1-2), and the difference was statistically significant (P<0.05) compared with the patients who completed follow-up, and the general baseline information of the patients is shown in Table 1. Table 1 General survey data of the enrolled patients at different follow-up times General Information Completed follow-up patients (n=87) Missed patients (n=19) Statistical values ( t/x 2 ) P Age (years) 68.11±13.36 69.09±12.67 0.292 0.771 Sex ratio (male/female) 46/41 16/3 6.307 0.012 BMI (kg/m 2 ) 21.33±6.04 24.12±8.64 1.678 0.096 Education level n(%) Elementary school and below 37 (42.83) 12 (63.16) 2.779 0.249 Middle School~High School 32 (36.78) 5 (26.31) University and above 18 (20.69) 2 (10.53) Occupation n(%) Farmers 30 (34.48) 16 (84.21) 15.836 <0.001 Workers 27 (31.03) 2 (10.53) Other Practitioners 30 (34.49) 1 (5.26) Place of residence n(%) City 52 (59.77) 6 (31.58) 5.002 0.025 Rural 35 (40.23) 13 (68.42) Number of chronic diseases n(%) 1-2 57 (65.52) 5 (26.31) 9.871 0.002 ≥3 30 (34.48) 14 (73.69) NYHA classification n(%) Level II 48 (55.17) 8 (42.11) 1.069 0.301 Class III 39 (44.83) 11 (57.89) Number of heart failure hospitalizations 1.6 (0.6,2.7) 2.3 (1.5, 3.3) Z =2.361 0.067 Comparison of patients' self-management ability and dichotomous coping ability at different survey times By scoring patients' self-management ability at admission, 6 months of discharge and 12 months of discharge, it was found that there was a decreasing trend in patients' self-management scores, and the difference was not statistically significant ( P<0 .05). For dyadic coping scores, patients' stress communication scores and cooperation scores at admission, 6 months and 12 months after discharge were significantly decreased, with statistically significant differences ( P<0 .05). Spousal support scores were significantly higher with a statistically significant difference ( P 0.05), as shown in Table 2. Table 2 Comparison of patients' self-management skills and dyadic coping skills at different survey times (` x ±s, n=87) Time Self-management Dyadic Coping Stress Communication Support Authorized Response Cooperation Negative response At the time of admission 53.60±14.47 11.21±2.84 15.29±4.18 6.34±1.26 15.87±3.20 9.88±2.11 6 Months 50.87±13.20 13.08±3.08 ** 16.03±4.45 6.53±1.34 14.18±2.45 **## 9.61±3.50 12 Months 48.22±12.63 * 10.55±4.00 ## 18.11±6.01 **## 6.24±1.63 12.25±3.03 **## 9.60±4.02 F 3.474 13.337 0.763 0.909 33.654 0.201 P 0.032 <0.001 0.001 0.404 <0.001 0.818 Note: * P <0.05, ** P <0.01 vs admission; # P <0.05, ## P <0.01 vs 6 months after discharge. Comparison of self-management ability and dyadic coping ability of patients or spouses of different genders By analyzing the patient's self-management ability and the dyadic coping ability of the patients and spouses, it was found that there was a decreasing trend in the self-management ability of male patients at admission, 6 months and 12 months after discharge, with statistically significant differences ( P <0.05). By contrast, a certain increasing trend in the self-management ability of female patients occurred at admission, 6 months and 12 months after discharge, but the differences were not significant. Male patients had comparable self-management ability scores at admission compared to female patients. However, at 6 months and 12 months of discharge, female patients had significantly elevated self-management ability than male patients ( P 0.05); the binary support coping scores of female patients were higher than those of male patients, but the difference was not statistically significant ( P> 0.05). The dyadic coping scores of male and female spouses showed a decreasing trend with a statistically significant difference in the dyadic coping scores of male spouses ( P< 0.05). The dyadic coping scores of female spouses were significantly higher than those of male spouses, and the difference was statistically significant ( P< 0.05), as shown in Table 3. Table 3 Comparison of self-management ability and dyadic coping ability of patients or spouses by gender ( x¯ ±s±s, n=87) Indicators At the time of admission 6 Months 12 Months F P Patient Self-Management Male 51.71±12.50 46.19±13.10 44.15±11.84 4.512 0.013 Female 55.73±16.30 56.12±11.32 52.80±12.04 0.750 0.475 Pairing t 1.296 3.757 3.375 P 0.198 <0.001 0.001 Patient binary response Male 58.39±6.76 56.73±6.89 53.67±7.61 5.225 0.007 Female 58.85±7.04 62.46±7.12 60.24±8.79 2.294 0.105 Pairing t 0.323 3.805 3.734 P 0.757 <0.001 <0.001 Spousal binary response Male (n=46) 58.55±10.64 55.25±9.65 46.24±7.48 12.601 <0.001 Female (n=41) 70.26±8.55 62.09±8.43 54.09±9.28 21.044 <0.001 Pairing t 8.002 4.979 6.143 P <0.001 <0.001 <0.001 Correlation between patients' dyadic coping and self-management ability A significant positive correlation between the level of self-dual coping and female patients' self-management ability was observed at admission, 6 months and 12 months after discharge ( P< 0.05). The higher the level of self-dual coping of female patients was, the higher the self-management ability patients exhibited. There was no significant correlation between female patients' self-management ability and spouse's dyadic coping level ( P> 0.05). Self-management ability of male patients was not significantly correlated with dyadic coping at 12 months of admission and discharge ( P> 0.05) but was significantly correlated with dyadic coping at 6 months of discharge ( P< 0.05). There was an obvious positive correlation ( P< 0.05) between male patients' self-management ability and dyadic coping of their spouses, as shown in Tables 4 and 5. Table 4 Correlation between dyadic coping and self-management ability in female patients ( r , n=87) Variables Self-management skills At the time of admission 6 Months 12 Months Patient binary response At the time of admission 0.337* 6 Months 0.303* 12 Months 0.325* Spousal binary response At the time of admission 0.676 6 Months 0.103 12 Months 0.212 Note: * P <0.05 Table 5 Correlation between dyadic coping and self-management ability in male patients (r, n=87) Variables Self-management skills At the time of admission 6 Months 12 Months Patient binary response At the time of admission 0.213 6 Months 0.378* 12 Months 0.208 Spousal binary response At the time of admission 0.388* 6 Months 0.329* 12 Months 0.361* Note: * P <0.05 Discussion Current status of self-management ability of patients with chronic heart failure Chronic disease management is a long-term process, and the level of self-management skills can directly affect the prognosis [11]. According to the previous studies, the improvement in self-management ability is beneficial to the quality of life and the prognosis of patients suffering CHF [12]. However, the over-dependence on the strained medical resources and the inadequate chronic disease management may lead to a continuous decrease in patients' self-management ability. In the present study, we followed 106 patients with CHF for one year, whose overall self-management ability showed a significant decreasing trend. The gender serves as a crucial factor influencing the self-management ability. In general, male patients displayed lower self-management ability than that of female patients, especially at 6 months and 12 months of follow-up ( P <0.05). This observation is consistent with the study conducted by Wen and co-workers [13,14]. Nonetheless, it is necessary to note that whether gender is a direct factor affecting the level of self-management needs to be further confirmed by a larger number of patient samples. Status of dyadic coping skills of patients and spouses with chronic heart failure CHF is a widespread cardiovascular disease that threatens human health and life and represents a huge burden on society [15]. CHF also has an impact on the interpersonal management of patients and spouses. Dyadic coping reflects the patients' and spouses' ability to cooperate with each other to face the stress of the illness. Positive dichotomous coping is essential to improve the mutual intimacy between patients and their spouses [16]. In this study, the dyadic coping ability scores of patients and spouses were investigated in a one-year follow-up of patients with CHF. The results demonstrated a statistically significant decrease in stress communication scores, cooperation scores, and negative coping scores at admission, 6 months and 12 months after discharge. There was some improvement in spousal support scores and empowered coping scores, but the differences were not statistically significant. A comparison of dyadic coping scores for patients and spouses by gender showed a decreasing trend for both male and female patients, but the difference was not statistically significant ( P> 0.05). And male patients displayed lower binary support coping scores than that of female patients( P >0.05). The dyadic coping scores of male and female spouses showed a decreasing trend, with a statistically significant difference in the dyadic coping scores of male spouses ( P <0.05). The dyadic coping scores of female spouses were significantly higher than those of male spouse ( P < 0.05). Correlation between self-management ability and dyadic coping in patients with chronic heart failure Although a wide variety of factors can influence the level of patient self-management ability, there have been no study elucidating the direct factor. This study analyzed the correlation between patients’ self-management ability and t dyadic coping. Consequently, a significant positive correlation between female patients' self-management ability and dyadic coping was observed at admission, 6 months and 12 months after discharge ( P< 0.05). The higher the level of self-dual coping of female patients was, the higher the self-management ability of patients exhibited. There was no significant correlation between female patients' self-management ability and spouse's dyadic coping level ( P> 0.05). While there was no significant correlation between self-management ability and dyadic coping in male patients at admission and 12 months of discharge ( P> 0.05), a significant correlation was monitored at 6 months of discharge ( P< 0.05). There was a significant positive correlation between self-management ability and dyadic coping of spouses in male patients ( P< 0.05). One previous study illustrated [17] that dyadic coping of both partners is of significance in terms of relationship satisfaction, and in particular, the dyadic coping ability of the spouse has a more direct positive effect on mutual relationship. Consistent with this, the present study also validated a correlation between female spouse's dyadic coping and male patients' self-management skills. Conclusions The level of self-management tends to decrease over time in patients with CHF. However, the level of self-management ability tends to increase in female patients. Meanwhile, there was a trend of decrease in dyadic coping levels over time in both CHF patients and spouses. Particularly, in male spouses, the longer the follow-up time was, the lower the dyadic coping levels was exerted. The correlation study also confirmed that the level of self-management ability of CHF patients was significantly correlated with gender and the dyadic coping level of spouses. Therefore, via elevating the dyadic coping level of patients' spouses, especially male spouses, the self-management ability of patients can be improved. The aforementioned findings provide a foundation for the future clinical nursing interventions to improve the life quality of CHF patients. Abbreviations ANOVA Analysis of Variance CHF Chronic Heart Failure DCI Dyadic Coping Inventory NYHA New York Heart Association Declarations Acknowledgements The authors would like to thank all the participants of this study. We would also like to extend our appreciation to all people who had welling helped us with their abilities. Author contributions Yin-Mei Shi and Zhi-Hong Tang contributed equally to this work as first authors. Ying-Mei Shi: bio-statistical analysis, validation. Ying-Mei Shi & Zhi-Hong Tang: bio-statistical analysis, manuscript writing, validation, data proofing. Jing Wang & Lei-Lei Liu & Dong-Hong Qi: data collection, validation. An-Nuo Liu: study design, manuscript preparation, bio-statistical analysis, data collection, IRB preparation. All authors read and approved the final manuscript. Funding Hefei Health and Health Applied Medical Research Key Project (Hwk2021zd001). Ethics approval and consent to participate The First People’s Hospital Ethics Committee approved the study on 5 July 2020 (document number: Lun Research Approval No. 2020 (89)). Written and signed consents for participation in and publication of the study were obtained from all the participants. Consent for publication “Not applicable”. Competing interests The author declares that they have no competing interests. Author details 1 School of Nursing, Anhui Medical University, Hefei 230031, China; 2 Department of Cardiology, Hefei First People's Hospital, Hefei 230031, China. References Špinar J, Špinarová L, Vítovec J. Pathophysiology, causes and epidemiology of chronic heart failure. Vnitr Lek.2018;64(9):834-838. Skrzypek A, Mostowik M, Szeliga M, Wilczyńska-Golonka M, Dębicka-Dąbrowska D, Nessler J. Chronic heart failure in the elderly: still a current medical problem. Folia Med Cracov.2018;58(4):47-56. Strøm A, Andersen KL, Korneliussen K, Fagermoen MS. Being "on the alert" and "a forced volunteer": a qualitative study of the invisible care provided by the next of kin of patients with chronic heart failure. J Multidiscip Healthc. 2015;8:271-7. Negarandeh R, Aghajanloo A, Seylani K. Barriers to Self-care Among Patients with Heart Failure: A Qualitative Study. J Caring Sci. 2020 Oct 20;10(4):196-204. Lang CC, Smith K, Wingham J, Eyre V, Greaves CJ, Warren FC, et al. A randomized controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Study. BMJ Open. 2018;8(4):e019649. Cai T, Qian J, Yuan C. Dyadic Coping in Couples With Breast Cancer in China. Cancer Nurs. 2021;44(6):E458-E466. Shi G, Shi T, Liu Y, Cai Y. Relationships between dyadic coping, intimate relationship and post-traumatic growth in patients with breast cancer: A cross-sectional study. J Adv Nurs. 2021;77(12):4733-4742. Chen M, Gong J, Cao Q, Luo X, Li J, Li Q. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples. Eur J Oncol Nurs. 2021;54:102035. Shi Xiaoqing. Construction of a self-management scale for patients with heart failure. Shanghai Jiaotong University, 2010. Xu F, Hilpert P, Randall AK, Li Q, Bodenmann G. Validation of the Dyadic Coping Inventory with Chinese couples: factororial structure, measurement invariance, and construct validity. Psychol Assess.2016;28(8): e127-40. Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res.2017;19(5): e172. Meng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: a meta-analysis [J]. Diabetes Metab Syndr.2021;15(4): 102176. Siabani S, Leeder SR, Davidson PM. Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies. Springerplus. 2013;2:320. Asano R, Newton PJ, Currow DC, Macdonald PS, Leung D, Phillips JL, et al. Rationale for targeted self-management strategies for breathlessness in heart failure. Heart Fail Rev. 2021;26(1):71-79. Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review[J]. BMC Public Health.2018;18(1): 975. Falconier MK, Jackson JB, Hilpert P, Bodenmann G. Dyadic coping and relationship satisfaction: a meta-analysis [J]. Clin Psychol Rev. 2015;42:28-46. Rusu PP, Nussbeck FW, Leuchtmann L, Bodenmann G. Stress, dyadic coping, and relationship satisfaction: a longitudinal study disentangling timely stable from yearly fluctuations[J]. PLoS One. 2020;15(4): e0231133. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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With the increasing aging problem, the number of elderly patients with chronic heart failure is gradually increasing in China. It not only seriously affects the quality of life of patients, but also poses a heavy burden to the family and society [3]. Therefore, how to improve the rehabilitation level of CHF patients, improve the quality of life and reduce the burden on families has emerged as a major concern in clinical research. Adherence to self-management behaviors is an important factor affecting the rehabilitation outcome of CHF patients and is one of the main reasons for relapse in readmission of CHF patients [4]. CHF patients are able to reduce the rate of readmission and the number of readmissions by improving self-management skills [5]. Despite the importance of self-management capacity, it is obscure what factors influence it, and how family support and social factors affect self-management. Dichotomous coping (dyadic coping) refers to a new division of tasks, whereby both partners should work together to perceive stress, and help each other in the stress coping process to maintain marital stability. Studies have found that dyadic coping contributes significantly to recovery from a variety of diseases (e.g., cancer and various chronic diseases) and promotes mutual intimacy of patients and spouses\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[6,7,8]. The correlation between the level of self-management and dyadic coping in CHF patients has not been reported. Therefore, this study used a longitudinal research method to investigate the correlation and influencing factors between different dyadic coping and self-management in CHF patients with attempt to direct the future clinical nursing interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a longitudinal study, and 106 pairs of CHF patients and spouses treated in the Department of Cardiology of the First People\u0026apos;s Hospital of Hefei from September 2020 to September 2021 were selected as study subjects. Inclusion criteria: (1) patients hospitalized with confirmed diagnosis of CHF and cardiac function NYHA classification of grade II-III; (2) age: 30 to 75 years old; (3) clear consciousness and stable vital signs; (4) no combined serious diseases of other organ systems; (5) normal cognition, able to understand and cooperate with instructions; (6) informed consent and signed informed consent form. Exclusion criteria: (1) the presence of congenital physical disabilities, deformities and other functional disorders; (2) and a history of serious complications of other systems and psychiatric disorders. (3) presence of significant cognitive impairment or hearing impairment; (4) declaration of unwillingness to participate in this study. Exclusion and detachment criteria: (1) subjects requested to withdraw from the study; (2) poor compliance, resulting in inability to judge the effect or incomplete collection of relevant data were excluded; (3) subjects with serious changes in condition or serious complications during the study period were not suitable for participation in the study, or patients who did not complete the last follow-up were treated as detached.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Methodology\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneral data of all patients were collected, mainly including age, gender, education, occupation, place of residence, marital status, residential status, monthly income level, number of chronic diseases, cardiac function classification, height, weight, and number of heart failure hospitalizations. The self-management ability of patients was assessed using the Heart Failure Self-Management Scale developed by Shi [9] in 2010, which has 4 dimensions: five entries of medication management, three entries of diet management, five entries of psychological and social adjustment management, and seven entries of symptom management (total of 20 entries). The Likert 4-point scale was used to assess patients\u0026apos; self-management level, where \u0026lt;60% was low, 60%-79% was moderate, and \u0026ge;80% was high. One point to four point indicated never, sometimes, often, and always, respectively, with a total score of 80 points. The scale was standardized by using the score rate, and the score rate equals the actual score of the scale/the highest score of the scale\u0026times;100%. The scale had a content validity of 0.98 and a Cronbach\u0026apos;s alpha coefficient of 0.78, with good reliability. The German version of the Dyadic Coping Inventory (DCI) [10]was used to assess the dichotomous support coping of all patients and spouses. All items were rated on a 5-point Likert scale (1~5: rarely to very frequent), which has good reliability with content validity of \u0026alpha;=0.67 to \u0026alpha;=0.87.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were instructed to fill in the above survey instrument at admission, 6 months and 12 months after discharge using the above survey instrument for patients and spouses. For patients who could not fill it out on their own, the investigator used pertinent instructions to explain that future generations would fill it out for them, distributed the recall on site and verified the questionnaire with the patients, and disease-related information was obtained by reviewing the patients\u0026apos; medical records and relevant medical examination reports. To ensure follow-up rate, the study had a separate folder and number for each patient. The investigator left the patient\u0026apos;s phone number or WeChat when the patient filled out the questionnaire for the 1\u003csup\u003est\u003c/sup\u003e time, distributed research gifts, and recorded the dates at admission, 6 months, and 12 months after discharge. Contact patients a day in advance to schedule a time to fill out the questionnaire to reduce the rate of missed visits. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were double-checked and imported into the database, and SPSS 23.0 software was used for data analysis. The measurement data conformed to normal distribution and were expressed by`\u003cem\u003ex\u003c/em\u003e\u0026plusmn;s, and t-test was used for comparison of two groups. Repeated measures data were analyzed by repeated measures ANOVA, and paired t-test was used for comparison between groups. Median M (\u003cem\u003eQ\u003csub\u003e25\u003c/sub\u003e, Q\u003csub\u003e75\u003c/sub\u003e\u003c/em\u003e) was used for non-normally distributed data, and non-parametric statistics was used for comparison between groups. Count data were expressed as n (%), and the chi-square test or Fisher\u0026apos;s exact test was used for comparison between groups. Correlation analysis of the correlation between self-management ability, and dyadic coping was performed using Spearman\u0026apos;s rank correlation analysis with a two-sided test level \u0026alpha;=0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eComparison of general information of enrolled patients and patients lost to follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt admission, all 106 pairs of patients completed the survey study and were discharged at 6 months (94 pairs) and 12 months (87 pairs). At 6 months of discharge, 10 male patients and 2 female patients were lost, and at 12 months of discharge, 6 male patients and 1 female patient were lost. The majority of the lost patients were male, elementary school educated, farmers, rural residents. The number of chronic diseases (1-2), and the difference was statistically significant (P\u0026lt;0.05) compared with the patients who completed follow-up, and the general baseline information of the patients is shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 General survey data of the enrolled patients at different follow-up times\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eGeneral Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003eCompleted follow-up patients (n=87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003eMissed patients (n=19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003eStatistical values (\u003cem\u003et/x\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e68.11\u0026plusmn;13.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e69.09\u0026plusmn;12.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eSex ratio (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e46/41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e16/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e6.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e21.33\u0026plusmn;6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e24.12\u0026plusmn;8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eEducation level n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eElementary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e37 (42.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e12 (63.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e2.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eMiddle School~High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e32 (36.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e5 (26.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eUniversity and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e18 (20.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e2 (10.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eOccupation n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eFarmers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e30 (34.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e16 (84.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e15.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eWorkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e27 (31.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e2 (10.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eOther Practitioners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e30 (34.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e1 (5.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003ePlace of residence n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e52 (59.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e6 (31.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e5.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e35 (40.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e13 (68.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eNumber of chronic diseases n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e57 (65.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e5 (26.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e9.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e30 (34.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e14 (73.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eNYHA classification n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eLevel II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e48 (55.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e8 (42.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.32835820895522%\"\u003e\n \u003cp\u003eClass III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.82089552238806%\"\u003e\n \u003cp\u003e39 (44.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.850746268656717%\"\u003e\n \u003cp\u003e11 (57.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.711340206185568%\"\u003e\n \u003cp\u003eNumber of heart failure hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\"\u003e\n \u003cp\u003e1.6 (0.6,2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\"\u003e\n \u003cp\u003e2.3 (1.5, 3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e=2.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.371134020618557%\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of patients\u0026apos; self-management ability and dichotomous coping ability at different survey times\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy scoring patients\u0026apos; self-management ability at admission, 6 months of discharge and 12 months of discharge, it was found that there was a decreasing trend in patients\u0026apos; self-management scores, and the difference was not statistically significant (\u003cem\u003eP\u0026lt;0\u003c/em\u003e.05). For dyadic coping scores, patients\u0026apos; stress communication scores and cooperation scores at admission, 6 months and 12 months after discharge were significantly decreased, with statistically significant differences (\u003cem\u003eP\u0026lt;0\u003c/em\u003e.05). Spousal support scores were significantly higher with a statistically significant difference (\u003cem\u003eP\u0026lt;0\u003c/em\u003e.05), and the difference in authorized coping scores was not statistically significant (\u003cem\u003eP\u0026gt;\u0026nbsp;\u003c/em\u003e0.05), as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 Comparison of patients\u0026apos; self-management skills and dyadic coping skills at different survey times (`\u003cem\u003ex\u003c/em\u003e\u0026plusmn;s, n=87)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"15.306122448979592%\"\u003e\n \u003cp\u003eSelf-management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" width=\"72.44897959183673%\"\u003e\n \u003cp\u003eDyadic Coping\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.73913043478261%\"\u003e\n \u003cp\u003eStress Communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28985507246377%\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73913043478261%\"\u003e\n \u003cp\u003eAuthorized Response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\"\u003e\n \u003cp\u003eCooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\"\u003e\n \u003cp\u003eNegative response\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e53.60\u0026plusmn;14.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e11.21\u0026plusmn;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\"\u003e\n \u003cp\u003e15.29\u0026plusmn;4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e6.34\u0026plusmn;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\"\u003e\n \u003cp\u003e15.87\u0026plusmn;3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e9.88\u0026plusmn;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e50.87\u0026plusmn;13.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e13.08\u0026plusmn;3.08\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\"\u003e\n \u003cp\u003e16.03\u0026plusmn;4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e6.53\u0026plusmn;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\"\u003e\n \u003cp\u003e14.18\u0026plusmn;2.45 \u003csup\u003e**##\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e9.61\u0026plusmn;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e48.22\u0026plusmn;12.63\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e10.55\u0026plusmn;4.00\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\"\u003e\n \u003cp\u003e18.11\u0026plusmn;6.01\u003csup\u003e**##\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e6.24\u0026plusmn;1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\"\u003e\n \u003cp\u003e12.25\u0026plusmn;3.03 \u003csup\u003e**##\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e9.60\u0026plusmn;4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e3.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e13.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\"\u003e\n \u003cp\u003e33.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01 vs admission; \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, \u003csup\u003e##\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01 vs 6 months after discharge.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of self-management ability and dyadic coping ability of patients or spouses of different genders\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy analyzing the patient\u0026apos;s self-management ability and the dyadic coping ability of the patients and spouses, it was found that there was a decreasing trend in the self-management ability of male patients at admission, 6 months and 12 months after discharge, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). By contrast, a certain increasing trend in the self-management ability of female patients occurred at admission, 6 months and 12 months after discharge, but the differences were not significant. Male patients had comparable self-management ability scores at admission compared to female patients. However, at 6 months and 12 months of discharge, female patients had significantly elevated self-management ability than male patients (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The total dyadic coping scores of patients and spouses were found to be decreasing in both male and female patients, but the difference was not statistically significant (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05); the binary support coping scores of female patients were higher than those of male patients, but the difference was not statistically significant (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05). The dyadic coping scores of male and female spouses showed a decreasing trend with a statistically significant difference in the dyadic coping scores of male spouses (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). The dyadic coping scores of female spouses were significantly higher than those of male spouses, and the difference was statistically significant (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05), as shown in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3 Comparison of self-management ability and dyadic coping ability of patients or spouses by gender (\u003cem\u003ex\u0026macr;\u003c/em\u003e\u0026plusmn;s\u0026plusmn;s, n=87)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eIndicators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003ePatient Self-Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e51.71\u0026plusmn;12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e46.19\u0026plusmn;13.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e44.15\u0026plusmn;11.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e4.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e55.73\u0026plusmn;16.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e56.12\u0026plusmn;11.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e52.80\u0026plusmn;12.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003ePairing t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e1.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e3.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e3.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003ePatient binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e58.39\u0026plusmn;6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e56.73\u0026plusmn;6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e53.67\u0026plusmn;7.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e5.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e58.85\u0026plusmn;7.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e62.46\u0026plusmn;7.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e60.24\u0026plusmn;8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e2.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003ePairing t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e3.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e3.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eSpousal binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eMale (n=46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e58.55\u0026plusmn;10.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e55.25\u0026plusmn;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e46.24\u0026plusmn;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e12.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003eFemale (n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e70.26\u0026plusmn;8.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e62.09\u0026plusmn;8.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e54.09\u0026plusmn;9.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e21.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003ePairing t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e8.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e4.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e6.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between patients\u0026apos; dyadic coping and self-management ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant positive correlation between the level of self-dual coping and female patients\u0026apos; self-management ability was observed at admission, 6 months and 12 months after discharge (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). The higher the level of self-dual coping of female patients was, the higher the self-management ability patients exhibited. There was no significant correlation between female patients\u0026apos; self-management ability and spouse\u0026apos;s dyadic coping level (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05).\u003c/p\u003e\n\u003cp\u003eSelf-management ability of male patients was not significantly correlated with dyadic coping at 12 months of admission and discharge (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05) but was significantly correlated with dyadic coping at 6 months of discharge (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). There was an obvious positive correlation (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05) between male patients\u0026apos; self-management ability and dyadic coping of their spouses, as shown in Tables 4 and 5.\u003c/p\u003e\n\u003cp\u003eTable 4 Correlation between dyadic coping and self-management ability in female patients (\u003cem\u003er\u003c/em\u003e, n=87)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"38.38383838383838%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"61.61616161616162%\"\u003e\n \u003cp\u003eSelf-management skills\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003ePatient binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.337*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e0.303*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0.325*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eSpousal binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 Correlation between dyadic coping and self-management ability in male patients (r, n=87)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"38.38383838383838%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"61.61616161616162%\"\u003e\n \u003cp\u003eSelf-management skills\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003ePatient binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e0.378*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eSpousal binary response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003eAt the time of admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.388*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e6 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e0.329*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.775510204081634%\"\u003e\n \u003cp\u003e12 Months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0.361*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eCurrent status of self-management ability of patients with chronic heart failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic disease management is a long-term process, and the level of self-management skills can directly affect the prognosis [11]. According to the previous studies, the improvement in self-management ability is beneficial to the quality of life and the prognosis of patients suffering CHF [12]. However, the over-dependence on the strained medical resources and the inadequate chronic disease management may lead to a continuous decrease in patients\u0026apos; self-management ability. In the present study, we followed 106 patients with CHF for one year, whose overall self-management ability showed a significant decreasing trend. The gender serves as a crucial factor influencing the self-management ability. In general, male patients displayed lower self-management ability than that of female patients, especially at 6 months and 12 months of follow-up (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). This observation is consistent with the study conducted by Wen and co-workers [13,14]. Nonetheless, it is necessary to note that whether gender is a direct factor affecting the level of self-management needs to be further confirmed by a larger number of patient samples.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatus of dyadic coping skills of patients and spouses with chronic heart failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCHF is a widespread cardiovascular disease that threatens human health and life and represents a huge burden on society [15]. CHF also has an impact on the interpersonal management of patients and spouses. Dyadic coping reflects the patients\u0026apos; and spouses\u0026apos; ability to cooperate with each other to face the stress of the illness. Positive dichotomous coping is essential to improve the mutual intimacy between patients and their spouses [16]. In this study, the dyadic coping ability scores of patients and spouses were investigated in a one-year follow-up of patients with CHF. The results demonstrated a statistically significant decrease in stress communication scores, cooperation scores, and negative coping scores at admission, 6 months and 12 months after discharge. There was some improvement in spousal support scores and empowered coping scores, but the differences were not statistically significant. A comparison of dyadic coping scores for patients and spouses by gender showed a decreasing trend for both male and female patients, but the difference was not statistically significant (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05). And male patients displayed lower binary support coping scores than that of female patients(\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). The dyadic coping scores of male and female spouses showed a decreasing trend, with a statistically significant difference in the dyadic coping scores of male spouses (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The dyadic coping scores of female spouses were significantly higher than those of male spouse (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between self-management ability and dyadic coping in patients with chronic heart failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough a wide variety of factors can influence the level of patient self-management ability, there have been no study elucidating the direct factor. This study analyzed the correlation between patients\u0026rsquo; self-management ability and t dyadic coping. Consequently, a significant positive correlation between female patients\u0026apos; self-management ability and dyadic coping was observed at admission, 6 months and 12 months after discharge (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). The higher the level of self-dual coping of female patients was, the higher the self-management ability of patients exhibited. There was no significant correlation between female patients\u0026apos; self-management ability and spouse\u0026apos;s dyadic coping level (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05). While there was no significant correlation between self-management ability and dyadic coping in male patients at admission and 12 months of discharge (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05), a significant correlation was monitored at 6 months of discharge (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). There was a significant positive correlation between self-management ability and dyadic coping of spouses in male patients (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). One previous study illustrated [17] that dyadic coping of both partners is of significance in terms of relationship satisfaction, and in particular, the dyadic coping ability of the spouse has a more direct positive effect on mutual relationship. Consistent with this, the present study also validated a correlation between female spouse\u0026apos;s dyadic coping and male patients\u0026apos; self-management skills.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe level of self-management tends to decrease over time in patients with CHF. However, the level of self-management ability tends to increase in female patients. Meanwhile, there was a trend of decrease in dyadic coping levels over time in both CHF patients and spouses. Particularly, in male spouses, the longer the follow-up time was, the lower the dyadic coping levels was exerted. The correlation study also confirmed that the level of self-management ability of CHF patients was significantly correlated with gender and the dyadic coping level of spouses. Therefore, via elevating the dyadic coping level of patients' spouses, especially male spouses, the self-management ability of patients can be improved. The aforementioned findings provide a foundation for the future clinical nursing interventions to improve the life quality of CHF patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA Analysis of Variance\u003c/p\u003e\n\u003cp\u003eCHF Chronic Heart Failure\u003c/p\u003e\n\u003cp\u003eDCI Dyadic Coping Inventory\u003c/p\u003e\n\u003cp\u003eNYHA New York Heart Association\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the participants of this study. We would also like to extend our appreciation to all people who had welling helped us with their abilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYin-Mei Shi and Zhi-Hong Tang contributed equally to this work as first authors. Ying-Mei Shi: bio-statistical analysis, validation. Ying-Mei Shi \u0026amp; Zhi-Hong Tang: bio-statistical analysis, manuscript writing, validation, data proofing. Jing Wang \u0026amp; Lei-Lei Liu \u0026amp; Dong-Hong Qi: data collection, validation. An-Nuo Liu: study design, manuscript preparation, bio-statistical analysis, data collection, IRB preparation. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHefei Health and Health Applied Medical Research Key Project (Hwk2021zd001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe First People\u0026rsquo;s Hospital Ethics Committee approved the study on 5 July 2020 (document number: Lun Research Approval No. 2020 (89)). Written and signed consents for participation in and publication of the study were obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Not applicable\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Competing interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSchool of Nursing, Anhui Medical University, Hefei 230031, China; \u003csup\u003e2\u003c/sup\u003eDepartment of Cardiology, Hefei First People\u0026apos;s Hospital, Hefei 230031, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u0026Scaron;pinar J, \u0026Scaron;pinarov\u0026aacute; L, V\u0026iacute;tovec J. 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A randomized controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Study. BMJ Open. 2018;8(4):e019649.\u003c/li\u003e\n\u003cli\u003eCai T, Qian J, Yuan C. Dyadic Coping in Couples With Breast Cancer in China. Cancer Nurs. 2021;44(6):E458-E466. \u003c/li\u003e\n\u003cli\u003eShi G, Shi T, Liu Y, Cai Y. Relationships between dyadic coping, intimate relationship and post-traumatic growth in patients with breast cancer: A cross-sectional study. J Adv Nurs. 2021;77(12):4733-4742. \u003c/li\u003e\n\u003cli\u003eChen M, Gong J, Cao Q, Luo X, Li J, Li Q. A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples. Eur J Oncol Nurs. 2021;54:102035. \u003c/li\u003e\n\u003cli\u003eShi Xiaoqing. Construction of a self-management scale for patients with heart failure. Shanghai Jiaotong University, 2010.\u003c/li\u003e\n\u003cli\u003eXu F, Hilpert P, Randall AK, Li Q, Bodenmann G. Validation of the Dyadic Coping Inventory with Chinese couples: factororial structure, measurement invariance, and construct validity. Psychol Assess.2016;28(8): e127-40. \u003c/li\u003e\n\u003cli\u003eHanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res.2017;19(5): e172. \u003c/li\u003e\n\u003cli\u003eMeng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: a meta-analysis [J]. Diabetes Metab Syndr.2021;15(4): 102176.\u003c/li\u003e\n\u003cli\u003eSiabani S, Leeder SR, Davidson PM. Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies. Springerplus. 2013;2:320.\u003c/li\u003e\n\u003cli\u003eAsano R, Newton PJ, Currow DC, Macdonald PS, Leung D, Phillips JL, et al. Rationale for targeted self-management strategies for breathlessness in heart failure. Heart Fail Rev. 2021;26(1):71-79. \u003c/li\u003e\n\u003cli\u003eGheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review[J]. BMC Public Health.2018;18(1): 975. \u003c/li\u003e\n\u003cli\u003eFalconier MK, Jackson JB, Hilpert P, Bodenmann G. Dyadic coping and relationship satisfaction: a meta-analysis [J]. Clin Psychol Rev. 2015;42:28-46. \u003c/li\u003e\n\u003cli\u003eRusu PP, Nussbeck FW, Leuchtmann L, Bodenmann G. Stress, dyadic coping, and relationship satisfaction: a longitudinal study disentangling timely stable from yearly fluctuations[J]. PLoS One. 2020;15(4): e0231133. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chronic heart failure, self-management, dyadic coping, correlation","lastPublishedDoi":"10.21203/rs.3.rs-2668085/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2668085/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and objective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhether the level of self-management with dyadic coping in chronic heart failure (CHF) patients remains unclear. We investigate the longitudinal changes and correlations between dyadic coping and self-management in patients with CHF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 106 pairs of chronic heart failure patients and spouses treated in the Department of Cardiology of the Hefei First People's Hospital were selected as study subjects between September 2020 and September 2021. The dyadic coping scale and self-management scale were used for the follow-up survey to analyze the changes and correlation between patients' self-management ability and dyadic coping.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe followed 106 patients (19 patients lost) CHF for one year, whose overall self-management ability showed a significant decreasing trend. Male patients displayed lower self-management ability than that of female patients, especially at 6 months and 12 months of follow-up (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). All patients and spouses showed similar decreasing trend in stress communication scores, cooperation scores, and negative coping scores, but the decreasing trend were more pronounced for male patients. There was a significant positive correlation between female patients' self-management ability and dyadic coping was observed at admission, 6 months and 12 months after discharge (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). While there was no significant correlation between self-management ability and dyadic coping in male patients at admission and 12 months of discharge (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), a significant correlation was monitored at 6 months of discharge (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). There was a significant positive correlation between self-management ability and dyadic coping of spouses in male patients (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVia elevating the dyadic coping level of patients' spouses, especially male spouses, the self-management ability of patients can be improved. The aforementioned findings provide a foundation for the future clinical nursing interventions to improve the life quality of CHF patients.\u003c/p\u003e","manuscriptTitle":"Relationship between dyadic coping and self-management in patients with chronic heart failure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-15 09:59:51","doi":"10.21203/rs.3.rs-2668085/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be5376cd-651e-48ec-b52b-fbe967053412","owner":[],"postedDate":"March 15th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-25T18:29:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-15 09:59:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2668085","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2668085","identity":"rs-2668085","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}