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，包括坚持治疗方案和有效的决策以及HF症状加重时的纠正措施。最近的报告表明，25-50%的HF患者有未被识别的认知障碍，但很少有人知道这种未被识别的认知障碍对患者自我管理的影响，以及对健康和卫生服务使用的影响。使用HF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HF男性和女性样本中认知功能障碍、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）认知功能障碍（记忆、注意力、整体和执行功能）与自我管理受损的各个方面（依从性知识、钠限制和药物治疗依从性、体重变化的症状监测以及寻求护理的决定和行动）有何关系？2)在调整医学、人口统计学和心理社会因素（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、SES、教育、健康素养;社会支持/护理人员协助、抑郁和焦虑）时，这些关系如何改变？3)认知障碍程度、自我管理质量、健康状况（HF症状严重程度、心肺健康状况、HF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）之间的关系如何？ 将在基线、21天依从性监测期间以及3、6、9和12个月随访时收集数据。虽然以前的研究通过对因HF加重入院后的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局之间的关系。前瞻性将允许研究有效自我管理治疗的患者以及自我管理效果较差的患者。此外，还将评价认知损害对维持复杂HF治疗方案和管理症状恶化的影响。本研究的结论将对筛查HF患者的认知功能障碍、识别高危患者以及设计和实施针对认知功能障碍HF患者的患者自我管理干预措施以改善健康结局具有重要意义。 公共卫生相关性：成人心力衰竭患者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，以及在HF症状加重时做出有效决策和采取纠正措施。最近的报告表明，25-50%的HF患者有未被识别的认知障碍，但很少有人知道这种未被识别的认知障碍对患者自我管理的影响，以及对健康和卫生服务使用的影响。使用HF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HF男性和女性样本中认知功能障碍、患者自我管理、健康和卫生服务使用之间的关系。本研究的结论将对筛查HF患者的认知功能障碍、识别高危患者以及设计和实施针对认知功能障碍HF患者的患者自我管理干预措施以改善健康结局具有重要意义。

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.