Abstract
BackgroundCognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients’ health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients’ engagement in HF self-care and health outcomes, carer strain and quality of life.Methods/designThe proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients’ baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients’ HF symptoms, and ratings of the patients’ level of engagement in HF self-care behaviours.DiscussionIf the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs.Trial registrationAustralian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False.
Highlights
Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients’ health outcomes
If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs
In preliminary analysis using Virtual Week to assess prospective memory (PM), we found that, compared with aged-matched healthy controls, HF patients had significant deficits across all types of PM tasks, even on those that minimised the demands for remembering the content of the task [31]
Summary
Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients’ health outcomes. The objective of this study is to examine the effects of prospective memory training on patients’ engagement in HF self-care and health outcomes, carer strain and quality of life. The impact of cognitive impairment in this vulnerable group of patients is significant as it contributes to worse health outcomes, poor engagement in self-care and increased mortality [5,7,8]. Optimal self-care is considered an important nonpharmacological aspect of HF management that stabilises symptoms and improves health outcomes [7]. As well as adhering to these HF therapies, patients are taught to recognise and manage changes in symptoms, and seek health advice when such changes occur [9]
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