# Targeting cognitive function and interoceptive awareness to improve self-management in patients with co-morbid heart failure and cognitive impairment.

> **NIH NIH R01** · MIRIAM HOSPITAL · 2022 · $754,306

## Abstract

PROJECT SUMMARY/ABSTRACT
Due to population ageing, heart failure (HF) is reaching pandemic proportions and is now the most common
hospital discharge diagnosis among older adults in the United States. HF carries an unfavorable prognosis,
with both 6-month hospital readmissions and 5-year mortality rates reaching 50%. To improve clinical
outcomes, it is critical that patients implement adequate self-care, i.e., they adhere to pharmacological and
lifestyle recommendations and monitor their symptoms to ensure they receive medical attention in a timely
fashion. Mild cognitive impairment (MCI) affects up to two-thirds of patients with HF and is a key barrier to their
ability to effectively implement self-care. Despite its negative impact on self-care and on clinical outcomes, only
a small number of self-care intervention studies specifically address MCI and interventions targeting this
important comorbidity are sorely needed. There is preliminary evidence that mindfulness training (MT) can
improve cognitive function in individuals with MCI. MT has also been shown to improve interoceptive
awareness, a skill which could increase the patient’s ability to recognize worsening of HF symptoms in a timely
fashion, receive treatment sooner, and potentially prevent re-admissions. Finally, by eliciting the relaxation
response, MT enhances vagal control, which has been associated with better cognitive function. This
application, designed in response to PAR-20-180 “Identifying innovative mechanisms or interventions that
target multimorbidity and its consequences” and in line with NIA interests, will leverage our expertise with
remote MT for patients with chronic conditions to conduct a phase II mechanistic RCT with the following
objectives: a) To study the effects of MT on cognitive function and interoceptive awareness in patients with co-
morbid MCI and HF, b) To assess whether improvements in these proximal factors could positively impact self-
care and c) To study the underlying physiological mechanisms by which MT could improve cognition in this
population. Stable outpatients (n=176) with HF and MCI will be randomly assigned to phone-delivered MT (a
weekly, 30-minute session for 8 weeks integrated with a 20-min guided daily individual practice via digital
recordings) plus enhanced usual care (EUC) or to EUC alone. Consistent with current recommendations, usual
care will be enhanced in both groups with self-care education materials. At baseline, 3 months (end of
treatment), and 9 months since baseline participants will undergo comprehensive assessments of cognitive
function, interoceptive awareness, HF self-care and other psycho-behavioral factors, cardiac vagal control, and
HF biomarkers. This is the first rigorous investigation of the effects of MT on cognitive function, interoceptive
awareness, and self-care in patients with co-morbid MCI and HF. Demonstrating that, by improving cognitive
performance and interoceptive awareness, MT promotes self-care in patie...

## Key facts

- **NIH application ID:** 10410772
- **Project number:** 1R01AG076438-01
- **Recipient organization:** MIRIAM HOSPITAL
- **Principal Investigator:** Elena Salmoirago-Blotcher
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $754,306
- **Award type:** 1
- **Project period:** 2022-05-05 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10410772

## Citation

> US National Institutes of Health, RePORTER application 10410772, Targeting cognitive function and interoceptive awareness to improve self-management in patients with co-morbid heart failure and cognitive impairment. (1R01AG076438-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10410772. Licensed CC0.

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