Exploring the association between self-care behaviour, knowledge and cognition in patients with heart failure: a secondary analysis from the HF-Wii study

Abstract Background Self-care is vital for patients with heart failure and is influenced by different factors, Knowledge and the ability to reflect on behaviors is important to make decisions on self-care. Cognition may also be an important factor in relation to both knowledge and self-care. It has been found that cognitive impairment in patients with heart failure is common, with a reported prevalence of 20–80%. Aim To explore association between self-care behaviour, knowledge and cognition in patients with heart failure. Methods This is a secondary analysis of the baseline measures from the HF-Wii study with data from 605 patients, mean age 70 ± 12, 29% female, 30 % in New York Heart Association Class III-IV. Data on self-care was collected with European Self-care Behaviour Scale (EHFScBS) (possible range 0-100). Knowledge was collected with the Dutch HF Knowledge Scale (possible range 0-15 points). Cognition was assessed Montreal Cognitive Assessment (MoCA). Knowledge was dichotomised into low vs. high knowledge (cut off 13) and cognition into mild, moderate or severe cognitive problems vs. no or light cognitive problems. Results The total score on the EHFScBS was 64.6 ± 21.0 with 41% (N=245) of the patients performing good self-care (score > 70). The mean score on the Dutch HF Knowledge Scale was 12.3 ± 1.9 and 308 patients had high knowledge (score > 13). The majority of the patients (61%; N=371) had mild cognitive problems and 195 (32%) had no or light cognitive problems with a mean MOCA score of 24.4 ± 3.8. Self-care was significantly correlated to total knowledge (r = .23; p < .001), but it was not correlated to cognition. Furthermore, there was a positive correlation between total knowledge and cognition (r = .43; p <.001). Out of the 308 patients with high level of knowledge (>13), 130 had mild, moderate or severe cognitive problems. The other 178 patients with high knowledge had no or only light cognitive problems. Patients with high knowledge had a significantly higher score on the self-care behavior scale, independently of their cognitive function. In a multivariable logistic regression analysis, higher age [odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02-1.06), better quality of life (OR .95; 95% CI .90 - .99) and higher levels of knowledge (OR 1.25; OR 1.13 – 1.38) were independently related to self-care. Conclusion HF knowledge and cognition are related in patients with heart failure, but only knowledge, not cognition, was independently related to self-care.