Category: Health and Health Care

8 - Systematic Review: Cognitive Interventions for People with Heart Failure


Purpose: Comorbidities like cognitive impairment create barriers in the self-care for people with chronic diseases. People with heart failure (HF) have a higher prevalence of cognitive impairment. The purpose of this study was to review and synthesize studies on the interventions aimed at improving the cognitive functioning of people with HF and studies on the intervention effects for those with cognitive impairment.



Methods: PubMed and CINAHL were searched with keywords “heart failure” AND “cogniti*” for the Randomized Clinical Trials. Characteristics of the study designs, samples and interventions and study findings were extracted and analyzed.


Findings: 14 articles were included. Sample size ranged from 17 to 317. More than 50% were male, White, married from outpatient with mean age from 51.6 to 77, and  high school education degree. The targeted cognitive functions including auditory cognitive training, computerized plasticity-based cognitive training, speed of processing trainings and exercise/cardiac rehabilitation were found to improve processing speed (auditory, speech, psychomotor, every-day speed of processing), memory (delayed recall memory, working memory, metamemory), attention/executive functions, and cognitive performance. The computerized plasticity-based cognitive training additionally decreased half of the costs of hospitalization and tests and improve IADLs. Nurse-based management program significantly improved the HF knowledge of people with cognitive impairment. The Chronic Disease Self-Management Program significantly improved the cognitive symptom management of people with HF. An intervention with novel pictorial medication sheet improved the medication adherence. Follow-up disease management programs did not find increased event-free survival among those with cognitive impairment while a multi-disciplinary program seemed to reduce HF hospital admissions. An APRN-led education-support intervention with memory enhancement strategies significantly improved functional status, self-efficacy, quality of life, metamemory, self-care knowledge and decreased depression.



Conclusions: Healthcare professionals should pay more attention to the cognitive impairment of HF patients. Cognitive screening and training will help tailor and improve the effects of the educational interventions. Multidisciplinary program could benefit the precise care for complex patients and nurses should play the leading role. Future studies with HF patients should test the long-term effectiveness of the cognitive interventions with larger sample sizes.


 

Wenhui Zhang

Graduate Research Assistant
School of Nursing, the University of Texas at Austin, Texas

Ms. Wenhui (Vivian) Zhang is a 4-th year PhD Candidate from the School of Nursing, the University of Texas at Austin. Her research interests focus on Aging & Health, especially on care for older adults with multiple chronic conditions. She is also a concurrent master student in biostatistics.