This application addresses a doctoral research training program that focuses on uncovering neurocognitive mechanisms of self-management in heart failure (HF) patients. A plan of coursework, seminars, and a research study are presented. The research training environment at Case Western Reserve University provides a rich set of resources for this training, including a new P30 Center of Excellence in Self-Management Research focused on uncovering the brain-behavior mechanisms of self-management of health, a neuroscience lab, and faculty with strong programs of research in heart failure self-management. Heart failure patients must self-manage their chronic disease to prevent exacerbations and hospitalizations. Influencing factors of self-management have been identified and include anxiety, depression, cognitive status, comorbidities, physical activity, and sleep quality. On the whole, interventions that target these factors have been unsuccessful. A promising cognitive mechanism underlying successful self-management may be interoceptive awareness, which is the ability to consciously sense stimuli in the body and is related to taking action. If interoceptive awareness is related to self-management, interventions targeted to increase interoceptive awareness can be tested. Therefore, the purpose of study is to test the following aims:
Aim 1 : Determine if there is an association between interoceptive awareness and self-management maintenance (adherence to sodium restriction, medication, and weight monitoring) and symptom management.
Aim 2 : Assess the potential moderating effects of influencing factors (anxiety, depression, cognitive status, comorbidities, physical function, and sleep quality) on the relationship between interoceptive awareness and self-management maintenance (adherence to sodium restriction, medication, and weight monitoring) and symptom management. Using a descriptive cross-sectional study design, a sample of 109 HF patients will be recruited from a prior study. To ensure adequate variance in self-management outcomes in this sample, we will evaluate the 24 hour urine sodium levels (an objective indicator of sodium intake) of participants from the prior study. Measures of interoceptive awareness will be obtained and its relationship to self-management assessed. The project will be completed with support from the student's interdisciplinary mentorship team. Dr. Dolansky has advanced knowledge and experience in heart failure self-management and Dr. Hughes has expertise in cognitive factors in heart failure.
Complex self-management is necessary for heart failure patients to prevent worsening of their disease and hospitalizations. This study will test how a patient's body awareness affects their ability to perform self- management. This is a promising new area to help patients successfully manage their heart failure.
