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

Background: 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. Purpose: 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. Methods: 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. Results: 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. Conclusions: 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-careconfidence might successfully improve self-care.