Heart ABC

Heart ABC: Adherence, Behavior, and Cognition

Sponsored by the National Institute of Health – National Heart, Lung, and Blood Institute (#1R01HL096710-01A1)

Successful self-management of heart failure (HF) depends on adhering to a complex treatment regimen, effective decision making and corrective action when HF symptoms are exacerbated. Recent reports indicate that 25-50% of HF patients have unrecognized cognitive impairment, yet little is known about the effects of this unrecognized cognitive impairment on patient self-management. Our aim is to assess the relationships among cognitive impairment, patient self-management, health, and health service. 

Study Abstract

This study involves a multidisciplinary team with expertise in the areas of cardiovascular behavioral medicine, neuropsychology, and patient self-management in patients with cardiovascular disease. This is a multi-site collaboration between Case Western Reserve University/University Hospitals and Kent State University/ Summa Health System.

Successful self-management of heart failure (HF) depends on self-management that includes adherence to the treatment regimen, effective decision making and corrective action when HF symptoms are exacerbated. Recent reports indicate that 25-50% of HF patients have unrecognized cognitive impairment, yet little is known about the effects of this unrecognized cognitive impairment on patient self-management and the resulting impact on health and health service use. Using the Biopsychosocial Model of HF Self-management, our study assesses the relationship between cognitive impairment, patient self-management, health, and health service use in a sample of 400 men and women with NYHA Class 2 and 3 HF.  

Research Questions

1. How is cognitive impairment (memory, attention, global and executive function) related to various aspects of impaired self-management (knowledge of adherence, adherence to sodium restriction and medications, symptom monitoring of weight changes, and decision and action to seek care)?

2. How are these relationships altered when adjusting for medical, demographics, and psychosocial factors (illness severity, comorbidity, physical, sensory and sleep impairments, previous HF hospitalization; age, gender, ethnicity, SES, education, health literacy; social support/caregiver assistance, depression, and anxiety)?

3. What are the relationships among degree of cognitive impairment, quality self-management, health status (severity of HF symptoms, cardiopulmonary health status, HF-related quality of life), and health service use (physician visit/call, emergency room use and hospitalization)?