Abstract Body (Do not enter title and authors here): [Background] Cognitive impairment (CI) is prevalent among patients with heart failure (HF) and is associated with adverse outcomes. Effective self-care management is crucial in preventing HF deterioration. However, the impact of CI on acquiring self-care management skills remains unclear.
[Hypothesis] CI impedes the acquisition of self-care management skills using the HF point system in patients with HF.
[Methods] We analyzed data from a prospective, multicenter HF registry that included 26 centers in Japan. Patients hospitalized for HF between July 2022 and June 2023 who underwent cognitive function testing were extracted. We introduced a new HF point self-care management system that assigns points to key HF symptoms (1 point for edema, dyspnea on exertion, heart rate >120 bpm; 3 points each for dyspnea at rest, and weight gain >5% above target). This system guides early ambulatory visits based on the total score of HF points. Patients were provided instruction on its use during hospitalization. Implementation of the system was assessed at discharge. CI was defined by Montreal Cognitive Assessment score <26. Logistic regression was used to evaluate the association between CI and implementation of the self-care management system. Cox proportional hazard model, adjusted for demographics, comorbidities, and medications, was used to assess the impact of the HF point system implementation on clinical outcomes.
[Results] Of the 618 patients (mean age 81±10.6 years, 49% male), 515 (83%) patients had CI. A total of 277 (45%) patients were able to implement our HF point self-care management system. Univariate analysis identified age, sex, anemia, dyslipidemia, GNRI, SPPB, and CI as factors associated with patients' implementation of the HF point self-care management system. Multivariate analysis showed that CI was an independent predictor of unsuccessful system implementation (odds ratio 0.395; 95% CI, 0.223-0.702; P=0.002). After a median follow-up of 14.4 months, patients who implemented the HF point self-care management system had significantly lower incidence of the composite outcome of all cause death and HF rehospitalization (adjusted HR 0.671; 95% CI, 0.46-0.97; P=0.03).
[Conclusions] The incidence of CI in HF patients is very high, and they are at high risk for poor self-care management. HF patients with CI may require tailored, intensive support to prevent HF deterioration after discharge.