Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment
Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment
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DOI：
10.1093/eurjhf/hfs096
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发表时间：
2012-09-01
影响因子：
18.2
通讯作者：
Allen, Jerilyn
中科院分区：
文献类型：
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作者：
Davis, Karen K.;Mintzer, Miriam;Allen, Jerilyn
轻度认知功能障碍（MCI）在心力衰竭中很普遍，并可能导致自我护理不良和较高的再入院率。改善MCI患者自我护理的策略尚未研究。这项随机对照试验旨在测试有针对性的干预措施对自我护理、心力衰竭知识和30天再入院率的影响。该研究包括125名因心力衰竭恶化住院的MCI筛查阳性患者。治疗组采用认知训练原则进行有针对性的自我护理教学干预。在基线和出院后30天评估自我护理、心力衰竭知识、抑郁和社会支持。干预组心力衰竭知识平均得分显著改善，但对照组下降（P 0.001）。当控制其他变量时，干预组患者的心力衰竭知识增加幅度大于对照组患者（P 0.027）。黑人与较低的心力衰竭知识评分显著相关（P 0.030）。与对照组相比，干预组自我护理的平均变化评分显示出更大的改善;然而，这并不具有统计学意义。各组再入院率无差异，对轻度认知障碍患者进行随机对照试验是可行的。治疗组患者在出院后30天有更多的心力衰竭知识;然而，这并不影响再入院率。需要进一步的研究来描述MCI如何影响自我护理和知识，以及种族和其他因素如何影响这一人群的结果。
Mild cognitive impairment (MCI) is prevalent in heart failure, and can contribute to poor self-care and higher hospital readmissions. Strategies to improve self-care in patients with MCI have not been studied. This randomized controlled trial aimed to test the effect of a targeted intervention on self-care, heart failure knowledge, and 30-day readmissions.The study included 125 patients hospitalized for exacerbation of heart failure who screened positive for MCI. The treatment group received a targeted self-care teaching intervention using principles of cognitive training. Self-care, heart failure knowledge, depression, and social support were assessed at baseline and 30 days post-discharge. Mean heart failure knowledge scores improved significantly in the intervention group, but decreased in the control group (P 0.001). When controlling for other variables, patients in the intervention group showed a greater increase in heart failure knowledge than patients in the control group (P 0.027). Black race was significantly associated with lower heart failure knowledge scores (P 0.030). Mean change scores for self-care showed greater improvement in the intervention group when compared with the control group; however, this was not statistically significant. There was no difference in readmission rates between the groups.It is feasible to conduct a randomized controlled trial in patients with MCI. Patients in the treatment group had greater heart failure knowledge at 30 days post-discharge; however, this did not impact readmission rates. Further research is needed to describe how MCI affects self-care and knowledge, and how race and other factors may influence outcomes in this population.