Currie Kay, Rideout Andrew, Lindsay Grace, Harkness Karen
Kay Currie, PhD, RN Reader in Applied Health Research, Nursing & Community Health, Glasgow Caledonian University, Scotland, UK. Andrew Rideout, MPH, RN Researcher, Nursing & Community Health, Glasgow Caledonian University, Scotland, UK. Grace Lindsay, PhD, RN Reader in Nursing, Nursing & Community Health, Glasgow Caledonian University, Scotland, UK. Karen Harkness, PhD, RN Assistant Clinical Professor, School of Nursing, McMaster University, Ontario, Canada.
J Cardiovasc Nurs. 2015 Sep-Oct;30(5):382-93. doi: 10.1097/JCN.0000000000000173.
Emerging evidence suggests that heart failure (HF) patients who have mild cognitive impairment (MCI) may experience greater difficulty with self-care.
This article reports a systematic review that addressed the objective "What is the evidence for an association between MCI and self-care, measured in 1 or more of the self-care domains related to HF, in adults who have a diagnosis of chronic HF?"
We adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the review and synthesis of quantitative research studies that formally measured both cognitive function and self-care in HF patients and sought to describe the relationship between these factors.
Ninety-one potentially relevant studies were located; 10 studies (2006-2014) were included. Because of heterogeneity in the retrieved studies, meta-analysis was not possible. Narrative synthesis found growing evidence regarding the association between MCI and adverse effects on self-care in HF. Nine studies reported significant positive associations between MCI and self-care in HF, either specifically in relation to medication adherence or more generic measures of self-care activity. One study reported a significant, negative correlation between cognitive function and self-care, suggesting that worse cognitive function was associated with better self-care; however, this is partially explained by a small sample size and mixed methodology.
These findings have implications for clinical practice. It is known that HF patients have difficulty with self-care, and the influence of cognitive function needs to be considered when providing professional support. Further research to determine the feasibility and acceptability of cognitive assessment in routine clinical care is recommended.
新出现的证据表明，患有轻度认知障碍（MCI）的心力衰竭（HF）患者在自我护理方面可能会遇到更大困难。
本文报告一项系统评价，其目标是“在已诊断为慢性HF的成年人中，与HF相关的1个或多个自我护理领域中测量的MCI与自我护理之间存在关联的证据是什么？”
我们采用系统评价和Meta分析的首选报告项目指南，对正式测量HF患者认知功能和自我护理的定量研究进行综述和综合，并试图描述这些因素之间的关系。
共检索到91项潜在相关研究；纳入了10项研究（2006 - 2014年）。由于检索到的研究存在异质性，无法进行Meta分析。叙述性综合分析发现，越来越多的证据表明MCI与HF患者自我护理的不良影响之间存在关联。9项研究报告了MCI与HF患者自我护理之间存在显著的正相关，要么具体与药物依从性有关，要么与更一般的自我护理活动测量有关。一项研究报告认知功能与自我护理之间存在显著的负相关，表明较差的认知功能与较好的自我护理相关；然而，这部分可以通过样本量小和方法混合来解释。
这些发现对临床实践具有启示意义。已知HF患者在自我护理方面存在困难，在提供专业支持时需要考虑认知功能的影响。建议进一步研究以确定在常规临床护理中进行认知评估的可行性和可接受性。
