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Predictors of Heart Failure Self-care in Patients Who Screened Positive for Mild Cognitive Impairment

Davis, Karen K. PhD, RN; Dennison Himmelfarb, Cheryl R. PhD, ANP; Szanton, Sarah L. PhD, CRNP; Hayat, Matthew J. PhD; Allen, Jerilyn K. ScD, RN, FAAN

Journal of Cardiovascular Nursing: March/April 2015 - Volume 30 - Issue 2 - p 152–160
doi: 10.1097/JCN.0000000000000130

Background: Heart failure (HF) is associated with cognitive impairment, which could negatively affect a patient’s abilities to carry out self-care, potentially resulting in higher hospital readmission rates. Factors associated with self-care in patients experiencing mild cognitive impairment (MCI) are not known.

Objective: This descriptive correlation study aimed to assess levels of HF self-care and knowledge and to determine the predictors of self-care in HF patients who screen positive for MCI.

Methods: The Montreal Cognitive Assessment was used to screen for MCI. In 125 patients with MCI hospitalized with HF, self-care (Self-care of Heart Failure Index) and HF knowledge (Dutch Heart Failure Knowledge Scale) were assessed. We used multiple regression analysis to test a model of variables hypothesized to predict self-care maintenance, management, and confidence.

Results: Mean (SD) HF knowledge scores (11.24 [1.84]) were above the level considered to be adequate (defined as >10). Mean (SD) scores for self-care maintenance (63.57 [19.12]), management (68.35 [20.24]), and confidence (64.99 [16.06]) were consistent with inadequate self-care (defined as scores <70). In multivariate analysis, HF knowledge, race, greater disease severity, and social support explained 22% of the variance in self-care maintenance (P < .001); age, education level, and greater disease severity explained 19% of the variance in self-care management (P < .001); and younger age and higher social support explained 20% of the variance in self-care confidence scores (P < .001). Blacks, on average, scored significantly lower in self-care maintenance (P = .03).

Conclusion: In this sample, patients who screened positive for MCI, on average, had adequate HF knowledge yet inadequate self-care scores. These models show the influence of modifiable and nonmodifiable predictors for patients who screened positive for MCI across the domains of self-care. Health professionals should consider screening for MCI and identifying interventions that address HF knowledge and social support. Further research is needed to explain the racial differences in self-care.

Karen K. Davis, PhD, RN Director of Nursing/Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.

Cheryl R. Dennison Himmelfarb, PhD, ANP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

Sarah L. Szanton, PhD, CRNP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

Matthew J. Hayat, PhD Assistant Professor, College of Nursing, Rutgers University, Newark, New Jersey.

Jerilyn K. Allen, ScD, RN, FAAN M. Adelaide Nutting Professor and Associate Dean for Research, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

Funding was provided through a Nursing Support Program I grant sponsored by the Health Services Cost Review Commission.

The authors have no conflicts of interest to disclose.

Correspondence Karen K. Davis, PhD, RN, Department of Medicine, Johns Hopkins Hospital, 1830 E Monument Street, Room 9061, Baltimore, MD 21287 (

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