Cognitive Impairment and Self-management in Adults with Heart Failure

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DESCRIPTION (provided by applicant): Self-management and Cognitive Impairment in Adults with Heart Failure Successful self-management of heart failure (HF) depends on self-management that includes adherence to the treatment regimen and effective decision making and corrective action when HF symptoms are exacerbated. Recent reports indicate that 25-50% of HF patients have unrecognized cognitive impairment, yet little is known about the effects of this unrecognized cognitive impairment on patient self-management and the resulting impact on health and health service use. Using the Biopsychosocial Model of HF Self-management, our aim is to assess the relationship between cognitive impairment, patient self-management, health, and health service use in a sample of 400 men and women with NYHA Class 2 and 3 HF. Research questions are: 1) How is cognitive impairment (memory, attention, global and executive function) related to various aspects of impaired self-management (knowledge of adherence, adherence to sodium restriction and medications, symptom monitoring of weight changes, and decision and action to seek care)? 2) How are these relationships altered when adjusting for medical, demographics, and psychosocial factors (illness severity, comorbidity, physical, sensory and sleep impairments, previous HF hospitalization; age, gender, ethnicity, SES, education, health literacy; social support/caregiver assistance, depression, and anxiety)? 3) What are the relationships among degree of cognitive impairment, quality self-management, health status (severity of HF symptoms, cardiopulmonary health status, HF-related quality of life), and health service use (physician visit/call, emergency room use and hospitalization)? Data will be collected at baseline, during 21 days of adherence monitoring, and at 3, 6, 9, and 12-month follow-up. Although previous studies have examined failures of patient self-management by interviewing patients after hospital admission for a HF exacerbation, this study is innovative in that it will examine relationships among cognitive function, self-management effectiveness and health outcomes in a prospective study. The prospective nature will allow for the study of patients that effectively self-manage their treatment as well as patients whose self-management is less effective. In addition, the effect of cognitive impairment on both the maintenance of the complex HF treatment regimen and the management of worsening symptoms will be evaluated. Conclusions from this study will have important implications for screening HF patients for cognitive impairment, identifying high risk patients, and designing and implementing patient self-management interventions targeted to cognitively impaired HF patients to improve health outcomes.