The risk of cognitive impairment in heart failure is high,
and such patients experience difficulty understanding
heart failure information and performing self-care
behaviours. There has been a widespread adoption of the
evidence-based disease management approaches
recommended in national and international guidelines
(NICE, 2010; McMurray et al, 2012; Seferovic et al,
2013). This has improved patient outcome. However, the
positive outcomes of early studies of structured disease
management approaches were largely affected by the
poor standard of care received by those in the ‘usual’ care
group. The widespread adoption of evidence-based
practices recommended in guidelines has improved
patient outcome. It is likely that any further improvement
will relate to the extent to which disease management
can be individualised. The routine assessment of factors
that impact on cognition and therefore on self-care
ability should be central to the planning and delivery of
tailored disease-management support and education.
This requires simple yet reliable assessment measures
and to date there is insufficient knowledge on which tool
is best to use and when. Cognitive impairment is now
well recognised as a significant comorbidity in those
with heart failure; seeking ways to accurately identify
those most at risk should now be a priority.