{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:56:10Z","timestamp":1773392170018,"version":"3.50.1"},"reference-count":70,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a single-center cross-sectional study (March 2022\u2013April 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 (\u22646, 7\u201312, 13\u201324, 25\u201348, &amp;gt;48\u2005h). Prespecified analyses comprised logistic regression for early presentation (\u22646\u2005h) 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\u2192Attitudes\u2192Self-care\u2192TTP pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 2,110 patients, recognition was highest for breathlessness\/edema\/fatigue (80%\u201385%), \u223c60% 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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,319), early presentation was more common with university\u2009+\u2009education (47.7% vs. 35.2%), higher NYHA (IV 48.9%, III 47.2%, I\u2013II 39.1%), and high knowledge (50.5% vs. 31.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Independent predictors of early presentation were NYHA IV (aOR 2.01, 95% CI 1.32\u20133.06), NYHA III (1.52, 1.17\u20131.98), and knowledge (per point 1.14, 1.07\u20131.22); lower education (0.68, 0.49\u20130.94), no action plan (0.71, 0.54\u20130.93), and no insurance (0.59, 0.37\u20130.94) reduced odds. Structural modelling indicated a knowledge effect (\u03b2\u2009=\u20090.423) mediated by attitudes and self-care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Content-specific education, written action plans, and access facilitation\u2014particularly for lower-education and uninsured groups\u2014are pragmatic levers to shorten patient-dependent delays in worsening HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1713344","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:48:55Z","timestamp":1773384535000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Recognition of worsening heart failure symptoms, help-seeking attitudes, and time-to-presentation in chronic heart failure: a single-center KAP study in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Han","family":"Han","sequence":"first","affiliation":[{"name":"Cardiology, The Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"399","DOI":"10.26599\/1671-5411.2023.06.001","article-title":"Report on cardiovascular health and diseases in China 2021: an updated summary","volume":"20","author":"Hu","year":"2023","journal-title":"J Geriatr 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