Abstract 9598: A Focused Heart Failure Self-Care Intervention Improves Self-Care Behavior Even in Patients with Global Cognitive Dysfunction

Abstract

Heart failure (HF) patients have high rates of global cognitive dysfunction (GCD). HF requires challenging levels of self-care for all, but may be particularly difficult for those with GCD. Objective: Determine the impact of tailored intervention focused on improving self-care of symptom management in HF patients with or without GCD. Methods: We randomized 614 (41.2% female; age 66 ± 13 years; 35.4% NYHA class III/IV) rural patients with HF to usual care or one of two active self-care symptom monitoring and management intervention groups (i.e., LITE and PLUS). Both intervention groups included tailored (to address individual barriers to self-care) education and counseling providing skills to recognize symptoms of escalating HF, tools to monitor symptoms and motivation to respond early. Intervention was delivered by an expert HF nurse. Intervention groups differed only in contact frequency; LITE group received two follow-up calls, while PLUS group received bi-weekly calls until judged trained. Cognitive function was assessed at baseline using the Mini-Cog; scores range from 0 to 6. Patients with overt dementia were excluded. GCD was defined as a score of 3 or 4. Self-care outcome data (HF Self-Care Behavior Scale) were collected at baseline, 3 and 12 months. Data were analyzed using repeated measures ANCOVA, controlling for age and education level. Findings: Of enrollees, 33.7% met criteria for GCD. Self-care improved in both intervention groups, but worsened in the usual care group (p < 0.001 for group by time interaction). Patients with and without GCD demonstrated improvements in self-care when assigned to either of the intervention groups, but not the usual care group (Figure).

Conclusion: Individualized intervention that includes focus on HF patients’ barriers to engaging in self-care is effective in improving self-care even in patients with GCD. A higher intensity of contact was not needed to achieve this effect.