Effective management of volume overload is essential for improving the prognosis of heart failure (HF), which is often complicated by exacerbations and rehospitalisations. Psychosocial and behavioural factors significantly influence volume status. However, studies directly linking these factors to volume overload in patients with HF remain limited.

This study aimed to model the direct and indirect influences of social support, cognition, self-efficacy, consideration of future outcomes, and self-care on volume overload in patients with HF to guide volume management interventions.

A cross-sectional study was conducted among 233 consecutively hospitalised patients with HF from a tertiary hospital in Chongqing, China (January–July 2023). Bioelectrical impedance analysis measured volume status, and psychosocial and behavioural variables were assessed using validated scales, including the Lubben Social Network Scale, Mini-Cog, General Self-Efficacy Scale, Consideration of Future Consequences Scale, and Self-Care of Heart Failure Index, Version 6.2 Behaviour Scale. Data were analysed using IBM SPSS Statistics, Version 26.0 and AMOS 24.0.

Among the patients (mean age=66.49±12.49 years; 43.35% women; 61.8% New York Heart Association stage III), 71% experienced volume overload. Path analysis showed that volume overload (oedema index) was directly and negatively associated with self-care maintenance (β=−0.263; p<0.001), cognition (β=−0.202; p<0.001), and self-efficacy (β=−0.199; p<0.01). Indirect negative effects were observed for social support (β=−0.203; p<0.001), self-care confidence (β=−0.090; p<0.001), and consideration of future outcomes (β=−0.057; p<0.001).

Factors such as social support, cognitive functioning, self-efficacy, future considerations, and self-care are significant contributors to the vulnerability of patients with HF to volume overload. This underscores the necessity for multifaceted interventions aimed at improving the prognosis of patients with HF.