Cognitive Impairment and Self-management in Adults with Heart Failure

描述（由申请人提供）：心力衰竭成人的自我管理和认知障碍心力衰竭（HF）的成功自我管理取决于自我管理，包括坚持治疗方案，在HF症状加重时有效的决策和纠正措施。最近的报告表明，25-50%的心衰患者存在未被识别的认知障碍，但人们对这种未被识别的认知障碍对患者自我管理的影响以及由此对健康和卫生服务使用的影响知之甚少。使用心衰自我管理的生物心理社会模型，我们的目的是评估400名NYHA 2级和3级心衰患者的认知障碍、患者自我管理、健康和卫生服务使用之间的关系。研究问题是：1)认知障碍（记忆、注意力、全局和执行功能）与自我管理受损的各个方面（依从性的知识、对钠限制和药物的依从性、体重变化的症状监测、寻求治疗的决定和行动）有何关系？2)在调整医疗、人口统计和社会心理因素（疾病严重程度、合并症、身体、感觉和睡眠障碍、既往HF住院、年龄、性别、种族、社会经济地位、教育程度、健康素养、社会支持/照顾者援助、抑郁和焦虑）后，这些关系是如何改变的？3)认知障碍程度、自我管理质量、健康状况（心衰症状严重程度、心肺健康状况、心衰相关生活质量）和健康服务使用（医生就诊/呼叫、急诊室使用和住院）之间的关系是什么？数据将在基线、21天依从性监测期间以及3、6、9和12个月的随访期间收集。虽然以前的研究通过对入院的心衰加重患者进行访谈来检查患者自我管理的失败，但本研究的创新之处在于，它将在前瞻性研究中检查认知功能、自我管理有效性和健康结果之间的关系。前瞻性的性质将允许研究患者有效地自我管理他们的治疗，以及患者的自我管理不太有效。此外，还将评估认知障碍对复杂心衰治疗方案维持和症状恶化管理的影响。本研究的结论将对心衰患者认知功能障碍筛查、识别高危患者、设计和实施针对心衰认知功能障碍患者的患者自我管理干预措施以改善健康结果具有重要意义。

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. PUBLIC HEALTH RELEVANCE: 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. 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.