Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction

Christopher Lee, Jill Gelow, Julie T. Bidwell, James Mudd, Jennifer K. Green, Corrine Y. Jurgens, Diana S. Woodruff-Pak

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)534-540
Number of pages7
JournalJournal of Cardiovascular Nursing
Volume28
Issue number6
DOIs
StatePublished - Nov 2013

Fingerprint

Self Care
Heart Failure
Aptitude
Cognitive Dysfunction
Stroke Volume
Observational Studies
Cardiovascular Diseases

Keywords

  • cognition
  • heart failure
  • self-care
  • self-management

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction. / Lee, Christopher; Gelow, Jill; Bidwell, Julie T.; Mudd, James; Green, Jennifer K.; Jurgens, Corrine Y.; Woodruff-Pak, Diana S.

In: Journal of Cardiovascular Nursing, Vol. 28, No. 6, 11.2013, p. 534-540.

Research output: Contribution to journalArticle

Lee, Christopher ; Gelow, Jill ; Bidwell, Julie T. ; Mudd, James ; Green, Jennifer K. ; Jurgens, Corrine Y. ; Woodruff-Pak, Diana S. / Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction. In: Journal of Cardiovascular Nursing. 2013 ; Vol. 28, No. 6. pp. 534-540.
@article{24660af1f4594c2ab311ecdbc405077c,
title = "Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction",
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.",
keywords = "cognition, heart failure, self-care, self-management",
author = "Christopher Lee and Jill Gelow and Bidwell, {Julie T.} and James Mudd and Green, {Jennifer K.} and Jurgens, {Corrine Y.} and Woodruff-Pak, {Diana S.}",
year = "2013",
month = "11",
doi = "10.1097/JCN.0b013e31826620fa",
language = "English (US)",
volume = "28",
pages = "534--540",
journal = "Journal of Cardiovascular Nursing",
issn = "0889-4655",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Blunted responses to heart failure symptoms in adults with mild cognitive dysfunction

AU - Lee, Christopher

AU - Gelow, Jill

AU - Bidwell, Julie T.

AU - Mudd, James

AU - Green, Jennifer K.

AU - Jurgens, Corrine Y.

AU - Woodruff-Pak, Diana S.

PY - 2013/11

Y1 - 2013/11

N2 - 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.

AB - 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.

KW - cognition

KW - heart failure

KW - self-care

KW - self-management

UR - http://www.scopus.com/inward/record.url?scp=84886598803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886598803&partnerID=8YFLogxK

U2 - 10.1097/JCN.0b013e31826620fa

DO - 10.1097/JCN.0b013e31826620fa

M3 - Article

VL - 28

SP - 534

EP - 540

JO - Journal of Cardiovascular Nursing

JF - Journal of Cardiovascular Nursing

SN - 0889-4655

IS - 6

ER -