Christopher S Lee1, Jill M Gelow, Julie T Bidwell, James O Mudd, Jennifer K Green, Corrine Y Jurgens, Diana S Woodruff-Pak. 1. Christopher S. Lee, PhD, RN Assistant Professor, School of Nursing, Oregon Health & Science University, Portland. Jill M. Gelow, MD, MPH Assistant Professor and Heart Failure Cardiologist, School of Medicine, Oregon Health & Science University, Portland. Julie T. Bidwell, BSN, RN PhD Student, School of Nursing, Oregon Health & Science University, Portland. James O. Mudd, MD Assistant Professor and Heart Failure Cardiologist, School of Nursing, Oregon Health & Science University, Portland. Jennifer K. Green, MS Research Associate, School of Nursing, Oregon Health & Science University, Portland. Corrine Y. Jurgens, PhD, RN Associate Dean for Research and Clinical Associate Professor, School of Nursing, Stony Brook University, New York. Diana S. Woodruff-Pak, PhD Professor of Psychology and Neurology, Neuroscience Program, Temple University, Philadelphia, Pennsylvania.
Abstract
INTRODUCTION: Mild cognitive dysfunction is common among adults with heart failure (HF). We hypothesized that mild cognitive dysfunction would be associated with poor HF self-care behaviors, particularly patients' ability to respond to symptoms. METHODS: We analyzed data on 148 participants in an observational study of symptoms in adults with moderate-to-advanced HF. Mild cognitive dysfunction was measured with the Montreal Cognitive Assessment (MoCA; range, 0-30), using cutoff scores for the general population (26) and for adults with cardiovascular disease (24). Heart failure self-care management (evaluation and response to HF symptoms) was measured with the Self-care of HF Index, and consulting behaviors (calling a provider when symptoms occur) were measured using the European HF Self-care Behavior Scale-9. Generalized linear modeling and hierarchical linear modeling were used to quantify the relationship between MoCA cutoff scores and indices of HF self-care. RESULTS: The mean age of the sample was 57 ± 12 years, 61.5% were men, and 58.8% had class III/IV HF; the mean left ventricular ejection fraction was 28% ± 12%. Using MoCA scores of 26 and 24, respectively, 33.1% and 14.2% of the sample had mild cognitive dysfunction. Controlling for common confounders, participants with MoCA scores lower than 26 reported self-care comparable with that of participants with MoCA scores of 26 or higher. Participants with MoCA scores lower than 24, however, reported 21.5% worse self-care management (P = 0.014) and 51% worse consulting behaviors (P < 0.001) compared with participants with MoCA scores of 24 or higher. CONCLUSIONS: A disease-specific cutoff for mild cognitive dysfunction reveals marked differences patients' ability to recognize and respond to HF symptoms when they occur. Adults with HF and mild cognitive dysfunction are a vulnerable patient group in great need of interventions that complement HF self-care.
INTRODUCTION: Mild cognitive dysfunction is common among adults with heart failure (HF). We hypothesized that mild cognitive dysfunction would be associated with poor HF self-care behaviors, particularly patients' ability to respond to symptoms. METHODS: We analyzed data on 148 participants in an observational study of symptoms in adults with moderate-to-advanced HF. Mild cognitive dysfunction was measured with the Montreal Cognitive Assessment (MoCA; range, 0-30), using cutoff scores for the general population (26) and for adults with cardiovascular disease (24). Heart failure self-care management (evaluation and response to HF symptoms) was measured with the Self-care of HF Index, and consulting behaviors (calling a provider when symptoms occur) were measured using the European HF Self-care Behavior Scale-9. Generalized linear modeling and hierarchical linear modeling were used to quantify the relationship between MoCA cutoff scores and indices of HF self-care. RESULTS: The mean age of the sample was 57 ± 12 years, 61.5% were men, and 58.8% had class III/IV HF; the mean left ventricular ejection fraction was 28% ± 12%. Using MoCA scores of 26 and 24, respectively, 33.1% and 14.2% of the sample had mild cognitive dysfunction. Controlling for common confounders, participants with MoCA scores lower than 26 reported self-care comparable with that of participants with MoCA scores of 26 or higher. Participants with MoCA scores lower than 24, however, reported 21.5% worse self-care management (P = 0.014) and 51% worse consulting behaviors (P < 0.001) compared with participants with MoCA scores of 24 or higher. CONCLUSIONS: A disease-specific cutoff for mild cognitive dysfunction reveals marked differences patients' ability to recognize and respond to HF symptoms when they occur. Adults with HF and mild cognitive dysfunction are a vulnerable patient group in great need of interventions that complement HF self-care.
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Authors: Julie T Bidwell; Ercole Vellone; Karen S Lyons; Fabio D'Agostino; Barbara Riegel; Marco Paturzo; Shirin O Hiatt; Rosaria Alvaro; Christopher S Lee Journal: Eur J Cardiovasc Nurs Date: 2017-05-17 Impact factor: 3.908