Abstract Body (Do not enter title and authors here): Introduction: The COOL-HF (caregiver (CG) opportunities for optimizing lifestyles) randomized clinical trial tested a psychoeducational intervention (with and without exercise) for caregivers of persons living with heart failure (HF) to address cardiovascular (CVD) risk factors due to the burden of caregiving. The analyses presented here examine the moderating effects of caregiver self-efficacy confidence on the associations between biomarkers of CVD risk.

Hypothesis: HF CGs with lower caregiving confidence will have stronger associations between adipokines, lipids and inflammatory biomarkers.

Methods: Cardiovascular risk for the HF caregivers was assessed by measuring inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), Interleukin-6 (IL6)), adipokines (adiponectin, plasminogen activator inhibitor-1 (PAI-1), resistin), lipids (low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, triglycerides) and insulin. Caregiver self-efficacy was measured using the family caregiver version of Self-Care of Heart Failure Index (SCHFI) competency scale. The moderating effects of caregiver competency on the associations between the biomarkers of cardiovascular risk were tested for measures at baseline using the PROCESS macro software.

Results: The 127 CGs in the study were aged 55 +/- 11, 92% female, 58% Black, 55% spouses and 70% had a college or higher education. Among care recipients, HF severity ranged from NYHA class I (25%), II (25%), III (38%), to IV (12%). SCHFI family caregiver competency scores ranged from 4-16 with an average score of 9.8 +/- 2.8 which significantly moderated the associations between adiponectin and triglycerides (β=0.177, p=.049), between adiponectin and insulin (β=0.222, p=.012), between adiponectin and PAI-1 (β=0.222, p=.021), and between PAI-1 and resistin (β=-0.246, p=.005), where lower levels of confidence led to stronger associations between these risk factors.

Conclusions: Caregiving burden is known to increase stress and cardiovascular risk in caregivers. These results support assessing caregivers for low caregiving competency levels which may increase the associations between biomarkers of cardiovascular risk. Targeted interventions that improve caregiver self-efficacy may moderate and reduce cardiovascular risk and improve overall health outcomes in caregivers of persons living with HF.