Affective symptoms, cognitive function and self-care behaviours in adults with heart failure according to ejection fraction phenotype

Aims: The aim of this study was to compare affective symptoms, cognitive dysfunction, and self-care behaviors among different heart failure (HF) phenotypes and to explore their interrelationships, particularly examining how cognitive and affective factors influence self-care practices. Methods and results: This cross-sectional study involved 250 older adults hospitalized for acute decompensated HF, categorized into three groups based on left ventricular ejection fraction (EF): HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF). Affective symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), while cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Self-care behaviors were measured using the European Heart Failure Self-Care Behavior Scale. Among participants, 42% had HFrEF, 18.4% had HFmrEF, and 39.6% had HFpEF. Cognitive dysfunction was more pronounced in HFpEF patients (MMSE median = 28.0, IQR = 26.0-29.0) compared to those with HFrEF (median = 28.0, IQR = 27.0-29.0) or HFmrEF (median = 29.0, IQR = 27.3-29.0, p = 0.008). Higher MMSE scores were significantly associated with better self-care behaviors in HFpEF patients (Spearman's r = -0.299, p = 0.003), but not in the other groups. Significant differences were found in specific self-care behaviors, including contacting healthcare providers and adherence to a low-sodium diet. Conclusion: Although variations in cognitive function and self-care behaviors were observed across heart failure phenotypes, these differences were not statistically significant after adjusting for demographic and clinical factors. Tailored interventions should be based on a comprehensive assessment of cognitive and emotional health, rather than heart failure phenotype alone.