Cognitive Impairment and Self-management in Adults with Heart Failure

描述(申请人提供)：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，其中包括坚持治疗方案，以及在心力衰竭症状恶化时做出有效的决策和纠正行动。最近的报告表明，25%-50%的心力衰竭患者存在未被识别的认知障碍，但对于这种未被识别的认知损伤对患者自我管理的影响以及由此对健康和健康服务使用的影响，人们知之甚少。利用心力衰竭自我管理的生物心理社会模型，我们的目的是评估400名患有NYHA 2级和3级心力衰竭的男性和女性的认知障碍、患者自我管理、健康和健康服务利用之间的关系。研究问题是：1)认知障碍(记忆、注意力、整体和执行功能)与受损的自我管理的各个方面(遵守知识、坚持限钠和药物、体重变化的症状监测以及寻求治疗的决定和行动)是如何相关的？2)当对医疗、人口统计和心理社会因素(疾病严重程度、共病、身体、感觉和睡眠障碍、既往心力衰竭住院；年龄、性别、种族、自闭症、教育、健康素养)进行调整时，这些关系是如何改变的；社会支持/照顾者帮助、抑郁和焦虑)？3)认知障碍程度、自我管理质量、健康状况(心力衰竭症状的严重程度、心肺健康状况、心力衰竭相关生活质量)和健康服务利用(医生就诊/电话、急诊室使用和住院)之间有什么关系？数据将在基线、21天的依从性监测期间以及3、6、9和12个月的随访时收集。虽然以前的研究通过访问入院后心力衰竭加重的患者来检查患者自我管理的失败，但这项研究是创新的，因为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。前瞻性研究将允许对有效自我管理治疗的患者以及自我管理效果较差的患者进行研究。此外，还将评估认知障碍对维持复杂的心衰治疗方案和处理不断恶化的症状的影响。本研究的结论将对筛选心力衰竭患者的认知功能障碍，识别高危患者，设计和实施针对认知功能受损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，其中包括坚持治疗方案，以及在心力衰竭症状恶化时做出有效的决策和纠正行动。最近的报告表明，25%-50%的心力衰竭患者存在未被识别的认知障碍，但对于这种未被识别的认知损伤对患者自我管理的影响以及由此对健康和健康服务使用的影响，人们知之甚少。利用心力衰竭自我管理的生物心理社会模型，我们的目的是评估400名患有NYHA 2级和3级心力衰竭的男性和女性的认知障碍、患者自我管理、健康和健康服务利用之间的关系。本研究的结论将对筛选心力衰竭患者的认知功能障碍，识别高危患者，设计和实施针对认知功能受损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.