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Trajectories of Cognitive Function, Affective Symptoms, and Self-Care in Heart Failure: A Prospective Cohort Study
Maria Próba1, Christopher S Lee, Quin E Denfeld
1Maria Próba, PhD, RN, Assistant Professor, Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Poland. Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA, Professor, Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts; Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, Poland. Quin E. Denfeld, PhD, RN, FAHA, FAAN, FHFSA, Associate Professor, Oregon Health & Science University School of Nursing, Portland. Heba Aldossary, PhD, RN, Assistant Professor, Department of Nursing, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia. Michał Czapla, PhD, RD, EMT-P, FESC, Associate Professor, Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, Poland; Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain; Nursing Care and Education Research Group (GRIECE), Department of Nursing, Faculty of Nursing and Podology, University of Valencia, Spain. Izabella Uchmanowicz, PhD, RN, MBA, FESC, FHFA, Professor, Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Poland; Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, United Kingdom.
Objective:
In this prospective cohort analysis, we examined 12-month trajectories of cognitive function, affective symptoms, and self-care in older adults with heart failure (HF) and evaluated whether baseline frailty modified these changes.
Methods:
In this prospective cohort study, 124 adults aged ≥60 years hospitalized for acute HF were assessed at baseline and at 6 and 12 months. Cognitive function was measured using the Mini-Mental State Examination (MMSE), affective symptoms using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), and self-care using the European Heart Failure Self-Care Behavior Scale (EHFSc-9). Longitudinal changes were analyzed using the Friedman test with post hoc Wilcoxon tests. Baseline frailty groups were compared using the Mann-Whitney U test. Exploratory correlations were evaluated using Spearman coefficients and were not corrected for multiple testing.
Results:
Cognitive performance declined significantly over 12 months (MMSE: 28.13 ± 1.69 to 26.14 ± 1.67; P = .001). Depressive symptoms increased over time (HADS-D: 2.72 ± 3.44 to 3.88 ± 3.97, P = .001; PHQ-9: 5.48 ± 4.82 to 6.44 ± 4.92, P < .001), while anxiety showed a modest increase (P = .003). Self-care scores remained stable (P = .151). Baseline frailty did not significantly influence the trajectory of affective symptoms or self-care. In exploratory, unadjusted analyses, depressive symptoms were correlated with self-care scores among patients with HF with preserved ejection fraction (PHQ-9 vs. EHFSc-9: r = -0.369, P = .019). Greater depressive burden was correlated with lower MMSE scores at 6 months (r = -0.161, P = .041).
Conclusions:
Older adults with HF demonstrated progressive cognitive decline and worsening affective symptoms over 12 months, whereas self-care remained relatively stable. Baseline frailty was not associated with any differential longitudinal changes. Exploratory correlations should be interpreted as hypothesis-generating.
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