title: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA ; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Hajduk
authors.forename: Stephenie C
authors.initials: SC
authors.lastname: Lemon
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Darleen M
authors.initials: DM
authors.lastname: Lessard
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
keywords: cognition; heart failure; self-care