The Relationship Between Caregivers' Contribution to Heart Failure Self-Care and Patient Self-Care: Exploring the Moderating Effect of Patient Cognitive Status

Abstract

Heart failure (HF) impacts millions worldwide and necessitates ongoing self-care, including maintenance, monitoring, and management, to prevent symptom worsening and hospitalization. Cognitive impairment, impacting memory, attention, and decision-making, is prevalent among patients with HF and may impede their self-care capabilities. In these instances, family caregivers frequently offer essential assistance. The effectiveness of this support in cases of cognitive impairment is not well established. Furthermore, other factors, including patient and caregiver self-efficacy, mental quality of life, and satisfaction with dyadic care may impact self-care, yet they remain insufficiently examined. This research employed a secondary analysis of data from 277 HF patient-caregiver dyads (N = 554) participating in a descriptive cross-sectional study conducted in Italy. Regression analyses, both multiple and moderated, were performed to investigate the relationships between caregiver contributions and patient HF self-care behaviors while evaluating the moderating effect of patient cognitive status and the impact of the covariates. The findings indicated that caregiver contributions were significant predictors of patient self-care in the domains of maintenance, monitoring, and management. Patient self-efficacy was identified as a significant and reliable predictor in all domains of self-care. The relationship between caregiver contribution and patient self-care maintenance and monitoring was significantly moderated by cognitive status, with caregiver support proving more effective for patients without cognitive impairment. Furthermore, caregiver satisfaction with dyadic care exhibited a negative correlation with self-care maintenance, while showing a positive correlation with self-care monitoring. The findings underscore the critical importance of caregiver support and patient self-efficacy in HF self-care, while also indicating that caregivers provide more support when there is no cognitive impairment. The results highlight the necessity of regular cognitive assessments and caregiver training when cognitive impairment exists to assist with HF self-management. The role of caregiver satisfaction indicates that relational dynamics may affect different aspects of self-care, necessitating further investigation. This research informs the creation of tailored interventions that include caregivers, with the goal of enhancing HF management.