Cognitive impairment negatively impacts self-efficacy in patients with chronic heart failure patients: results from the Cognition.Matters-HF study

Abstract

Abstract Background Cognitive impairment is highly prevalent in patients with chronic heart failure (HF), but evidence on its relationship with health-related quality of life (HRQoL) is sparse. We aimed to examine whether cognitive impairment is associated with HRQoL. We hypothesized that cognitive impairment would negatively impact HRQoL. Methods A total of 148 outpatients with chronic stable HF (mean LV ejection fraction 43±8%) were enrolled in the Cognition.Matters-HF prospective cohort study: mean age 64±11 years, 16% women, 77% in NYHA functional class I-II. Patients were extensively evaluated within 2 days by cardiological, neurological, and neuropsychological testing and brain magnetic resonance imaging (MRI). Severity of cognitive deficits were categorized based on the domains affected according to neurocognitive test battery results: 0 domains (“none”, n=46 [31%]), 1–2 domains (“mild”, n=77 [52%]), and >2 domains (“severe”, n=24 [16%]). HRQoL was measured with the generic Short-Form 36 (SF-36) and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Multivariable analysis of variance and regression modelling were applied to model associations between cognitive impairment and HRQoL. Results Cognitive impairment was not associated with overall scores of SF-36 and KCCQ nor any of the subscales, with the exception of the self-efficacy scale of the KCCQ. Self-efficacy represents the ability of patients to care for themselves; it quantifies a patient's unterstanding of how to prevent heart failure exacerbations and manage arising complications. Self-efficacy was negatively associated with cognitive impairment (beta=−0.242; p=0.004) and was rated 15% lower (B=−0.148) per increment in cognitive deficit category. The association of self-efficacy with cognitive impairment remained significant after adjustment for duration and severity of HF, age, and sex (p<0.001). Conclusions With the exception of self-efficacy, the severity of cognitive impairment was not associated with lower HRQoL in patients with chronic HF. The self-efficacy scale of the KCCQ is a promising tool potentially suited to detect individuals, who are unable to adhere to a proper HF treatment regimen. These patients may benefit from enhanced care, e.g. in the frame of a HF nurse led management program. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BMBF