Self-care confidence totally mediates the influence of simple attention and working memory on self-care in adults with heart failure

Cognition is impaired in 25-50% of heart failure (HF) patients. Cognitive impairment may affect patients' abilities to perform HF self-care. The situation-specific theory of HF self-care proposes that self-care confidence may mediate the relationship between cognition and self-care, but little is known about this issue. 

The purpose of this study was to test the hypothesis that self-care confidence mediates the relationship between specific cognitive domains (simple and complex attention, processing speed, working memory, and short-term memory) and HF self-care. 

This was a secondary analysis of data from a longitudinal cohort comparative study. A sample of 280 adults with chronic HF were enrolled from 3 outpatient settings in the USA. Self-care was measured with the Self-Care of HF Index, which measures self-care maintenance (i.e., monitoring of HF symptoms and adherence to treatments), self-care management (i.e., recognizing and managing symptoms of HF exacerbation), and self-care confidence (i.e., confidence in each of the self-care processes). Cognition was measured with a battery of neuropsychological tests. Sociodemographic characteristics, illness duration, HF type, comorbidity, and NYHA functional class were measured. The mediation model was tested with structural equation modeling using baseline data. 

Patients were 62 (SD, 12.5) years old on average, mostly male (64.3%) and functionally compromised (NYHA class III, 58.6%). Most (93.2%) patients had at least 1 test in which they demonstrated impaired cognition. In mediation analysis, self-care confidence totally mediated the relationship between simple attention and self-care (self-care maintenance and management) and between working memory and self-care (self-care maintenance and management). Processing speed, complex attention, and short-term memory were neither mediated by self-care confidence nor had a significant relationship with self-care maintenance and management. However, short-term memory had a significant direct effect on self-care maintenance. The tested models had acceptable fit indices.

 Results of this study suggest that self-care confidence might compensate for impaired cognition in HF patients. That is, patients with confidence in their ability to perform self-care may do well in spite of impaired cognition. Because cognitive impairment is so difficult to modify, interventions focused on self-care confidence might successfully improve self-care.