*4.3.9 Cognitive status*

Heart failure causes neurohormonal, inflammatory, and hemodynamic abnormalities, which are thought to contribute to all cognitive disorders. There is at least a mild-level cognitive disorder in approximately 70% of patients with heart failure, and this has been shown to be associated with poor self-care.

## **4.4 The monitoring of self-care in patients with advanced heart failure**

The monitoring of self-care behaviours is a data collection tool. The European Cardiology Association guidelines recommend regular follow-up of heart failure patients by healthcare providers. Symptom monitoring can be supported by distant follow-up or the personal monitoring by family members, unofficial carers, and healthcare specialists. The importance of vital findings and symptoms in patients with advanced heart failure has been stated in all the guidelines. The methods that can be useful in the monitoring of symptoms by the patients themselves and by healthcare professionals can be grouped as mHealth Tools and paper-based tools to determine the signs of heart failure, and medical devices and tools consulted by healthcare specialists to determine the signs of heart failure [40].
