Acute decompensated heart failure (HF), which usually requires hospitalization for medical management, is a time of important health care decision-making, self-care management education, and is associated with new or worsening symptoms, including dyspnea, fatigue, depression and pain. However, cognitive dysfunction impairs the ability of HF patients to focus their attention and remember self-care management information (e.g., medications, diet, symptom management strategies) contributing to their poor learning and impaired self-care management performance. Further adding to the complexity of self-care management for HF patients is the co-occurrence of multiple co-morbid conditions, such as hypertension, diabetes mellitus and hyperlipidemia that also require cognitive function to self-manage, in addition to their HF. This complexity is not limited to the acute phase of HF, but continues as a long-term consequence that contributes to post hospital placements in extended and long-term care facilities. Twenty-six percent of HF patients are discharged to extended care facilities and 21% to long-term care institutions, which may represent, in part, the inability to engage in self-care activities necessary to manage the multiple complexities of their chronic disease. For the remaining majority of HF patients who are discharged home, the need to balance engagement in physical activities, adherence to prescribed medication regimens, self-monitor one’s health status and engage in self-care management behaviors to maximize function, independence and quality of life further adds to the complexity of self-care management.

Approximately 50% of HF hospitalizations are preventable and are commonly caused by poor self-care management practices; the inability to maintain health and manage multiple comorbidities using positive health practices. In a recent study, of 53 hospitalized acute HF patients, we showed that symptoms of dyspnea, pain and depressed mood were associated with reduced attention and working memory speed, while pain and fatigue were associated with reduced accuracy of attention and working memory.

This study will examine the feasibility of developing and pilot testing a promising nurse-led, home-based cognitive remediation training intervention designed to maintain or improve cognitive function and thereby improve self-care management of HF. This approach includes the development of an electronic platform to deliver a nurse-led cognitive assessment and self-care educational (CASE) intervention along with a nurse enhanced cognitive remediation training (CRT) via the HIPAA Bridge Network. Once developed, the feasibility of delivering the intervention via computer will be pilot tested in 30 adults who were hospitalized for acute HF and recently discharged home. If effective, this intervention has the potential to improve self-care management and to decrease 30 day hospital readmission rates for people with HF.

Specific Aim 1: To develop the computer interface to deliver a nurse-led CASE and nurse-enhanced CRT and to evaluate feasibility and acceptability in 30 adults with HF.

Specific Aim 1a. To evaluate the feasibility and acceptability of this approach by HF patients and the study nurse.

Specific Aim 2 (Exploratory): To conduct an exploratory evaluation of the relationship between

• improvements in self-care management behaviors as measured by the Self Care Heart Failure Index (e.g., symptom management, taking medications as prescribed, daily weights, dietary restrictions, recognizing and responding to changes in signs and symptoms, evaluating effectiveness of self-care management strategy)
• fidelity of the nurse enhanced CRT, and
• change in cognitive status in 30 adults with HF.

Specific Aim 2a. To evaluate if improvements in self-care management behaviors are affected by fidelity of CRT as measured by subjects’ progress through the CRT program and by changes in cognitive state as measured by the Telephone Interview of Cognitive Status (TICS-M).

Specific Aim 3 (Exploratory): To describe 30-day hospital readmission rates for HF patients and compare to existing benchmarks.