Does cognitive impairment predict poor self-care in patients with heart failure?
OBJECTIVE
Cognitive impairment occurs often in patients with chronic heart failure (CHF) and may contribute to sub-optimal self-care. This study aimed to test the impact of cognitive impairment on self-care.


RESULTS
In 93 consecutive patients hospitalized with CHF, self-care (Self-Care of Heart Failure Index) was assessed. Multiple regression analysis was used to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. Variables in the model were mild cognitive impairment (MCI; Mini-Mental State Exam and Montreal Cognitive Assessment), depressive symptoms (Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis, and co-morbid illnesses. Sixty-eight patients (75%) were coded as having MCI and had significantly lower self-care management (eta(2)= 0.07, P < 0.01) and self-confidence scores (eta(2)= 0.05, P < 0.05). In multivariate analysis, MCI, co-morbidity index, and NYHA class III or IV explained 20% of the variance in self-care management (P < 0.01); MCI made the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (P < 0.01).


CONCLUSIONS
Cognitive impairment, a hidden co-morbidity, may impede patients' ability to make appropriate self-care decisions. Screening for MCI may alert health professionals to those at greater risk of failed self-care.
Cameron
Jan
J
School of Nursing & Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia. Jan.CAMERON@svhm.org.au
Worrall-Carter
Linda
L
Page
Karen
K
Riegel
Barbara
B
Lo
Sing Kai
SK
Stewart
Simon
S
D000367:Age Factors; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders; D015897:Comorbidity; D016001:Confidence Intervals; D003657:Decision Making; D003863:Depression; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006333:Heart Failure; D006801:Humans; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011594:Psychometrics; D012307:Risk Factors; D012651:Self Medication; D012737:Sex Factors; D012934:Social Isolation; D013223:Statistics as Topic; D014739:Victoria