Cognitive impairment and self-care in heart failure

Abstract

Background

Heart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF.

Design

Prospective cohort study.

Setting and participants

A total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada.

Measurements and methods

Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors.

Results

A total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models.

Conclusion

Cognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs.

Keywords:

• heart failure
• cognition
• self-care

Acknowledgments

We wish to thank Catherine Emery, RN, Bruce Barton, PhD, and Aimee Kroll, MPH, for their assistance in data collection and statistical analyses. This research was made possible through funding from the National Institutes of Health (RO1 HL77248). Dr Saczynski was supported in part by funding from the National Institute on Aging (K01AG33643), Dr McManus was supported in part by funding from the NIH (KL2RR031981), and Ms Hajduk and Drs Saczynski, McManus, Gurwitz, and Goldberg were supported in part by funding from the National Heart Lung and Blood Institute (U01HL105268). Dr Spencer is supported by a Career Investigator Award from the Heart and Stroke Foundation of Canada.

Author contributions

Alexandra M Hajduk contributed to concept and design, data analysis, and preparation of the manuscript; Darleen M Lessard, to data acquisition and analysis, and preparation of manuscript; David D McManus, to clinical expertise and preparation of the manuscript; Stephenie C Lemon, to preparation of the manuscript, study design/data acquisition; Jerry H Gurwitz, to preparation of manuscript and interpretation of data; Frederick A Spencer, to preparation of the manuscript, study design/data acquisition; Robert J Goldberg, to study PI, concept and design, and preparation of the manuscript; Jane S Saczynski, to concept and design and preparation of the manuscript. All authors critically reviewed and approved the final proof of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.