image: Kent State University researchers and psychologists Dr. John Gunstad (left) and Dr. Joel Hughes (right) will study cognitive impairment in heart failure patients with a $2.7-million grant awarded to the university by the National Institutes of Health. view more
Credit: Photo courtesy of Kent State University
The National Institutes of Health (NIH) has awarded a $2.7-million grant to Kent State University for a collaborative research project with Case Western Reserve University School of Nursing, Summa Health System in Akron and University Hospitals Case Medical Center in Cleveland to study cognitive impairment in heart failure patients. The four-year grant from NIH's National Heart, Lung, And Blood Institute runs through Jan. 31, 2014.
The goal of the study is to improve patient health and reduce medical system costs by understanding why heart failure patients have trouble managing their complex medical regimen. An important public health issue, there are five million heart failure patients in the United States with $43 billion spent in health care costs for these patients. Heart failure is also the largest category of hospital admittance among those on Medicare.
"When people have heart failure, they often have some level of cognition impairment," explained Dr. Joel Hughes, associate professor of psychology at Kent State and co-principal investigator of the grant. "By cognitive impairment, we mean that a patient's memory may not be as good as it used to be, they have more difficulty sustaining attention, or they cannot make decisions as quickly. These impairments are not as extreme as dementia or Alzheimer's, but executive functions, like those you make when driving a car, may have been adversely affected."
Little is known about how the cognitive status of heart failure patients affects management of their illness. "We know there's impairment," Hughes said. "If you have a mild cognitive impairment, we think it's harder to manage your illness, but there is no clear evidence of this."
The study, which is called "The Heart ABC Study: Adherence, Behavior and Cognition," aims to evaluate how cognitive abilities in heart failure patients relate to self-management behaviors. A mild cognitive impairment can affect a heart failure patient's ability to remember to take their medications, for example.
"This study will have important practical implications because we will be able to identify which types of cognitive impairment are related to specific problems in self-management to better target how to help these people learn to manage their own illness," said Dr. Mary Dolansky, assistant professor of nursing at Case Western Reserve University's Frances Payne Bolton School of Nursing and co-principal investigator of the grant.
"Patient self-management is the concept that chronic diseases can be very complex to manage by yourself," Hughes said. "You have to take your medication, limit your sodium intake, be able to weigh yourself each day, be able to recognize when something changes, and know what to do about it. It is up to the patient to manage themselves. How well you manage your disease affects how well you are going to be."
The grant-funded research brings together experts in medicine, nursing and psychology to take an interdisciplinary approach at studying cognitive impairment and self-management in heart failure patients. Kent State will work with Summa's Akron City Hospital, while Case Western Reserve University will work with University Hospitals. Each site will recruit 200 patients, representing a broad mix of people between the ages of 50 and 85 years old in the Cleveland and Akron areas.
Hughes said this is "a collaboration in the best sense" involving himself, an expert in health psychology; Kent State's Dr. John Gunstad, a neuropsychologist; Dolansky, an expert in patient self-management; Shirley Moore, a professor and associate dean of research and director of the Self-Management Research Center at the Frances Payne Bolton School of Nursing; and well-known cardiologists Dr. Joseph Redle of Summa and Drs. James Fang and Richard Josephson, both of Case/University Hospitals of Cleveland.
The study participants will be assessed and monitored. Daily electronic monitoring will be conducted the first month, examining the patient's weight, which medications were taken and when, and their sodium intake. Afterward, the participants will receive monthly calls from the researchers for updates and their use of health services.
Prevention is important among heart failure patients. "If we help people with heart failure stay out of the hospital and stay healthy, we can help reduce chronic illness in society," Hughes said.
The NIH grant also demonstrates the strength of Kent State's Department of Psychology. "This is a large grant for our department, and it builds a clear strength in health psychology and chronic health disease," said Hughes, who has been with the university for seven years. "We now have more than $5 million in current funding in the area of heart failure. It's also a very satisfying accomplishment for me personally, as this is a great step toward becoming an established investigator."