Log in to MyACC
Factors Associated With Self-Care in Patients With HF With and Without Cognitive Impairment
Study Questions:
Which patient factors are related to self-care in patients with and without mild cognitive impairment (MCI)?
Methods:
This cross-sectional observational study of 132 outpatients in 2 academic medical centers in Korea measured cognitive function and self-care in patients with heart failure (HF). Exclusion criteria included non-cardiac life-threatening conditions, referral for heart transplant, dementia, stroke or traumatic brain injury, and no hospitalization within 3 months of enrollment. Stepwise linear regression was used to identify which of 6 factors (HF knowledge, perceived control, functional status, multimorbidity, executive function, and social support) were predictive of self-care in patients with and without MCI.
Results:
Of the 132 patients recruited, 27.3% were found to have MCI. Self-care maintenance and management and confidence were measured in all patients, and most scored low in these areas regardless of cognitive function (84.1%, 94.6%, and 89.4% with low scores, respectively). Intact cognitive function appeared to be positively associated with only 1 self-care item measured: taking an extra dose of diuretic in response to worsening symptoms. Positive predictors of self-care were different in patients with intact and impaired cognitive function. In patients without MCI, perceived control was associated with self-care maintenance and management (p < 0.001 and p = 0.019, respectively.) In patients with MCI, self-care was predicted by social support (p = 0.002), with 24% of variance in self-care explained by social support alone (r2 = 0.239). Higher executive function scores in patients with MCI was also associated with better self-care maintenance (p = 0.006).
Conclusions:
In patients without cognitive impairment, better self-care was associated with perceived control. In patients with mild cognitive impairment, better self-care was associated with social support and executive function.
Perspective:
In chronic HF, a patient’s ability to engage in self-care maintenance and management will have an impact on their survival and quality of life. For clinicians caring for patients with HF, it is important to note that the majority of patients in this study were struggling with self-care, no matter their cognitive status. As seen in earlier studies, limitations in cognitive function were not predictive of poor self-care. Also, although many HF teaching interventions focus on knowledge acquisition, in this study HF knowledge was not associated with better self-care in either group. Given the positive effect of social support on self-care in patients with some degree of cognitive impairment, evaluating patients’ social support and focusing interventions on caregivers could have a significant positive impact. Interventions that improve executive function in these patients may also be effective. In patients with intact cognitive function, interventions to improve self-efficacy in order to improve a patient’s perceived control and engagement may be more effective. This study demonstrates the need for assessment of cognitive function in patients with HF and the importance of tailored educational interventions for patients with differing levels of cognitive function.
Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure
Keywords: Heart Failure, Cognitive Dysfunction, Cognition, Self Care, Self Efficacy, Quality of Life, Social Support, Patient Care, Caregivers, Republic of Korea
< Back to Listings
