# Recognition of worsening heart failure symptoms, help-seeking attitudes, and time-to-presentation in chronic heart failure: a single-center KAP study in China

## TL;DR

This study in China finds that better knowledge and attitudes about heart failure symptoms help patients seek care faster, reducing delays in treatment.

## Contribution

The study introduces a KAP framework linking patient knowledge, attitudes, and practices to time-to-presentation in worsening heart failure.

## Key findings

- High recognition of common symptoms like breathlessness and edema, but poor recognition of less obvious signs like confusion and oliguria.
- Education level, NYHA class, and knowledge were strong predictors of early help-seeking behavior.
- Structural modeling showed that knowledge influences time-to-presentation through attitudes and self-care practices.

## Abstract

Timely recognition and prompt help-seeking for worsening heart failure (HF) mitigate deterioration, yet patient-side delays remain common in China. This study evaluated how knowledge, attitudes, and practices (KAP) relate to time-to-presentation (TTP).

In a single-center cross-sectional study (March 2022–April 2025), adults with chronic HF completed a standardized KAP instrument; clinical data were abstracted. Among those with a worsening episode in the prior six months, TTP was categorized (≤6, 7–12, 13–24, 25–48, >48 h). Prespecified analyses comprised logistic regression for early presentation (≤6 h) adjusted for education, NYHA class, knowledge (per-point), written action plan, and insurance; ordinal models for knowledge categories; and structural-equation modeling of the Knowledge→Attitudes→Self-care→TTP pathway.

Among the 2,110 patients, recognition was highest for breathlessness/edema/fatigue (80%–85%), ∼60% for weight gain/orthopnea, and lowest for paroxysmal nocturnal dyspnea, dizziness/fainting, confusion/sleepiness, and oliguria (45%, 42%, 39%, 33%). Attitudes were favorable (early help-seeking 90%; trust 87%; self-efficacy 78%), but barriers were common (clinic hours/crowding 42%; costs 37%; transport 29%). Self-care diverged (medication adherence 83%; daily weight 21%). Latent classes (Proactive, Ambivalent, Barrier-Focused) and knowledge domains (Classical, Advanced, Acute-change) were observed. Among those with recent worsening (n = 1,319), early presentation was more common with university + education (47.7% vs. 35.2%), higher NYHA (IV 48.9%, III 47.2%, I–II 39.1%), and high knowledge (50.5% vs. 31.9%; p < 0.001). Independent predictors of early presentation were NYHA IV (aOR 2.01, 95% CI 1.32–3.06), NYHA III (1.52, 1.17–1.98), and knowledge (per point 1.14, 1.07–1.22); lower education (0.68, 0.49–0.94), no action plan (0.71, 0.54–0.93), and no insurance (0.59, 0.37–0.94) reduced odds. Structural modelling indicated a knowledge effect (β = 0.423) mediated by attitudes and self-care.

Content-specific education, written action plans, and access facilitation—particularly for lower-education and uninsured groups—are pragmatic levers to shorten patient-dependent delays in worsening HF.