Distinct Factors Associated With Better Self-care in Heart Failure Patients With and Without Mild Cognitive Impairment

Abstract

Background A decline in cognition may limit patients' ability to effectively engage in self-care in those with heart failure (HF). However, several studies have shown no difference in self-care between HF patients with and without cognitive impairment. This may indicate that there are more salient factors associated with self-care in HF patients with cognitive impairment compared with those without cognitive impairment. Objective The aim of this study was to explore which factors are related to self-care based on the presence and absence of mild cognitive impairment (MCI) among patients with HF. Methods Patients with HF were recruited from outpatient settings. The Montreal Cognitive Assessment was used to screen for MCI. Self-care was measured with the Self-care of HF Index v.6.2. Two separate stepwise linear regressions were performed to identify which factors (HF knowledge, perceived control, functional status, multimorbidity, executive function, and social support) predicted self-care in HF patients with and without MCI. Results Of the 132 patients in this study, 36 (27.3%) had MCI. Self-care maintenance and management were associated with social support (β = 0.489) and executive function (β = 0.484), respectively, in patients with MCI. Perceived control was associated with both self-care maintenance and management in patients without MCI (βs = 0.404 and 0.262, respectively). Conclusion We found that social support and executive function were associated with self-care in HF patients with MCI, whereas perceived control was associated with self-care in HF patients with intact cognition. Clinicians should develop tailored interventions to enhance self-care by considering the distinct factors associated with self-care based on the presence or absence of MCI.

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

“…Sociodemographic variables are only a small proportion of the factors known to influence behavior. Clearly factors such as access to care and social support are important determinants of self-care in persons with HF (Lee et al, 2019). Future studies that capture the full range of SDH indicators and are grounded in theory are warranted to explain the intricate relationships between SDH and HF self-care behavior.…”

The Situation-Specific Theory of Heart Failure Self-care

“… 22 This association is not surprising, because self-care behaviors require memory and cognitive skills (eg, remembering to take medications and understanding symptom changes). 23 , 24 A study using magnetic resonance imaging–based diffusion tensor imaging revealed that lack of brain tissue integrity in executive function regulatory regions was associated with poorer HF self-care maintenance and self-care management. 25 Poor self-care may be responsible for the higher mortality rates 26 and increased risk of 30-day rehospitalization in persons with HF and cognitive impairment.…”

The Utility of Cognitive Screening in Asian Patients With Heart Failure: A Systematic Review

“…Tables 1 , 2 summarize the main characteristics of the 21 included studies. Studies were conducted in Asian regions, including China ( n = 16) ( 19 , 37 – 50 , 52 ), Japan ( n = 3) ( 34 , 35 , 51 ), Korea ( n = 1) ( 36 ), and Singapore ( n = 1) ( 19 ). Nine of the 21 included studies ( 19 , 34 , 35 , 37 , 40 , 42 , 50 – 52 ) used the MMSE as a cognitive screening tool, while there were 14 studies ( 19 , 36 , 38 , 39 , 41 , 43 – 49 , 52 , 53 ) used the MoCA and 1 study ( 51 ) used the Mini-Cog.…”