Cognitive and self-care changes in patients with heart failure in the Amazon Region




Heart failure; Self care; Cognition; Epidemiology.


Heart failure is characterized as the lack of blood pumping capacity performed by the heart, which is considered a public health problem worldwide. Due to HF, the individual can develop clinical aspects that impact cognitive function and, consequently, self-care. Therefore, this study aimed to investigate cognitive changes and self-care in patients affected by HF and compare it with the cognitive and self-care changes of healthy participants. This is a quantitative, epidemiological, cross-sectional case-control study carried out at an institution in the city of Belém, Pará, Brazil. The following tests were used for data collection: Montreal Cognitive Assessment, Digit Symbol Substitution Test, European Heart Failure Self-care Behavior Scale (EHFScBS). Data were tabulated in Microsoft Excel 2010 and statistically treated by Epi Info version 3.5.2 with a 5% significance level and considering a 95% confidence interval in all analyzes. It was observed that patients with HF have slightly better self-care compared to patients without HF with scores obtained by EHFScBS equal to 29.7 ± 6.9 and 31.8 ± 8.2, respectively. Additionally, patients with HF showed impairments in the three cognitive domains, and women with HF demonstrated greater cognitive impairment compared to the other participants. The present study provides data to help build new approaches to interventions by the multidisciplinary team to promote better self-care and avoid cognitive impairments in patients with HF.

Author Biography

João Victor Moura Garcia, Universidade Federal do Pará

Acadêmico de Medicina da Universidade Federal do Pará


Albuquerque, D.C., Souza Neto, J.D., Bacal, F., Rohde, L.E.P., Pereira, S.B., Berwanger, O. & Almeida, D.R. (2015). I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospital Outcomes. Arq. Bras. Cardiol., 104: 433-42. DOI: 10.5935/abc.20150031.

Boisvert, S., Proulx-Belhumeur, A., Gonçalve, N., Francoeur, J. & Gallani, M.C. (2015). An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev. Latino-Am. Nursing, 23 (4): 753-68. DOI: 10.1590/0104-1169.0370.2612.

Bonin, C.B., Saints, R.Z, Erkmann, N., Souza, V.F., Assisi, A.V. & Benetti, M. (2016). Knowledge About Heart Failure in Participants and Non-Participants Cardiac Rehabilitation. International Journal of Cardiovascular Sciences, 29 (6): 453-459. DOI: 10.5935/2359-4802.20170001.

Brazil. Ministry of Health. (2019a). Mortality Information System (SIM), 1996-2017. Brasilia: Ministry of Health. Available at:

Brazil. Ministry of Health. (2019b). SUS Hospital Information System (SIH/SUS). Brasilia: Ministry of Health. Available at:

Carvalho, M.F.O. (2014). Evidencia de validade do millon behavioral medicine diagnostico na avaliação de aderência terapêutica em pacientes com insuficiência cardíaca crônica. Natal Rio Grande do Norte. Disponível em:

Conceição, A.P., Santos, M.A., Santos, B. & Cruz, D.A.L.M. (2015). Self-care of patients with heart failure1. Rev. Latino-Am. Nursing, 23 (4): 578-86. DOI: 10.1590/0104-1169.0288.2591.

Coordinating Committee of the Heart Failure Directive (CCDIC). (2018). Brazilian Guideline for Chronic and Acute Heart Failure. Arq. Bras. Cardiol., 111 (3): 436-539. DOI: 10.5935/abc.20180190.

Ferreira, V.M.P., Silva, L.N., Furuya, R.K., Schmidt, A., Rossi, L.A & Dantas, R.A.S. (2015). Self-care, sense of coherence and depression in patients hospitalized for decompensated heart failure. Rev Esc Enferm USP, 49 (3): 388-394. DOI: 10.1590/S0080-623420150000300005.

Galioto R., Fedor A.F. & Gunstad J. (2015). Possible neurocognitive benefits of exercise in persons with heart failure. Eur Rev Aging Phys Act, 12 (6): 1-7. DOI:

Hajduk, A.M., Lemon, S.C., McManus, D.D., Lessard, D.M., Gurwitz, J.H., Spencer, F.A., Goldberg, R.J. & Saczynski, J.S. (2013). Cognitive impairment and self-care in heart failure. Clin Epidemiol, 5: 407-16. DOI: 10.2147/CLEP.S44560.

Jaarsma, T., Strömberg, A., Mårtensson, J. & Dracup, K. (2003). Development and testing of the European Heart Failure Self-Care Behavior Scale. European Journal of Heart Failure, 5: 363-370. DOI: 10.1016/S1388-9842(02)00253-2.

Kim, J.S. & Shin, J.H. (2012). Cognitive Function and Self-Care in Patients with Heart Failure: A Pilot Study from Korean Patients. Perspectives in Nursing Science, 9 (1): 45-50. Available at:

Margoto, G., Colombo, R.C.R. & Gallani, M.C.B.J. (2009). Clinical and psychosocial features of heart failure patients admitted for clinical decompensation. Rev. Esc. Sick USP, 43 (1): 44-53. DOI:

Medeiros, J. & Medeiros, C.A. (2017). Self-care assessment in patients with heart failure. Cogitare Enferm, (22) 3: e51082. DOI:

Nascimento, H.R. (2012). Self-care in heart failure: comparative study between patients of specialized clinic and emergency room. University of Sao Paulo. Nursing school. Available at:

Nasreddine, Z., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J.L. & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for Mild Cognitive Impairment. American Geriatrics Society, 53, 695-699.

Parissis, JT, Mantziari, L., Kaldoglou, N., Ikonomidis, I., Nikolaou, M., Mebazaa, A., Altenberger, J., Delgado, J., Vilas-Boas, F., Paraskevaidis, I. ,Anastasiou-Nana, M. & Follath, F. (2013). Gender-related differences in patients with acute heart failure: management and predictors of in-hospital mortality. Int J Cardiol, 168 (1): 185-9. DOI: 101016/j.ijcard.2012.09.096.

Rêgo, M.L.M., Cabral, D.A.R. & Fontes, E.B. (2018). Cognitive Deficit in Heart Failure and the Benefits of Aerobic Physical Activity. Arq. Bras. Cardiol., 110 (1): 91-94. DOI:

Riegel, B., Lee, C. & Dickson, V.V. (2011). Self-care in patients with chronic heart failure. Nat Rev Cardiol, 8 (11): 644-54. DOI: 10.1038/nrcardio.2011.95.

Rockwell, J.M. & Riegel, B. (2001). Predictors of self-care in persons with heart failure. Heart Lung, 30 (1): 18-25. DOI: 10.1067 / mhl.2001.112503.

Rosano, C., Perera, S., Inzitari, M., Newman, A.B., Longstreth, W. T. & Studenski, S. (2016). Digit Symbol Substitution test and future clinical and subclinical disorders of cognition, mobility and mood in older adults. Age and Ageing, 45 (5): 688-695. DOI:

Sauvé, M., Lewis, W.R., Blanklenbiller, M., Rickabaugh, B. & Pressler, S.J. (2009). Cognitive impairments in chronic heart failure: a case controlled study. J Card Fail, 15 (1): 1-10. DOI: 10.1016/j.cardfail.2008.08.007.

Simões, M.R., Freitas, S., Santana, I., Firmino, H., Martins, C., Nasreddine, Z. & Vilar, M. (2008). Montreal Cognitive Assessment (MoCA): Portuguese final version. Psychological Assessment Service, Faculty of Psychology and Educational Sciences, University of Coimbra. Coimbra.

Sousa, M.S., Almeida, T.C.F., Gouveia, B.L.A., Marta, F.C., Brito, F.M. & Oliveira, S.H.S. (2018). Relationship between self-care and social and clinical conditions of patients with heart failure. Rev. Rene, 19: e33062. DOI:

Uchmanowicz, I. Polańska, J.,Mazur, G. & Froelicher, E.S. (2017). Cognitive deficits and self-care behaviors in elderly adults with heart failure. Clinical Interventions in Aging, 12, 1565-1572. DOI:




How to Cite

VERÍSSIMO, A. de O. L.; HONORATO, J. P.; COSTA, S. D. M.; GARCIA, J. V. M.; SILVA, I. J. R. da; XAVIER, S. S.; RAMOS, A. M. P. C.; TYLL, M. G. Cognitive and self-care changes in patients with heart failure in the Amazon Region. Research, Society and Development, [S. l.], v. 9, n. 6, p. e98963321, 2020. DOI: 10.33448/rsd-v9i6.3321. Disponível em: Acesso em: 31 jan. 2023.



Health Sciences