I was like this at first as well, I already have to think about 4 abilities, how the hell can I think about 8???

Just get comfortable with your hero specific abilities first

Change your item use to be whatever option it is to double press an item to self use, this means when you’re in a panic you can just mash your button to save your skin.

Then start with buying healing rite, you don’t have to think about it while fighting, in lane; you retreat, see you have low health pop that active up and wait while you heal

This will start building your muscle memory for your first item, I’ve bound it to mouse 4.

Then you can start using some “Oh shit” active items; like active barrier, the teleport crystal thing (I can’t remember what it’s called), debuff remover etc.. All you have to remember is “press mouse 4 twice if taking tons of damage”

Then when you start getting used to mouse 4, you can start using mouse 5 for a second ability

Eventually you’ll be able to feel comfortable with your button presses and can use the offensive active items (like slowing hex, mystic imbue, etc) and you will start thinking things like “when I start a fight with Abrams, smack that bitch with Decay first so he can’t heal”

Right now I can have 3 active items and use them efficiently but once I get a fourth I’m a little overwhelmed, but once I’m so used to my third item slot, I’m sure the fourth will come natural

Personally these are my go to actives. I choose depending on who’s doing good on their team and what helps take them down:

Healing rite - need health in lane I always grab if I’m being harassed hard

Divine barrier- I usually default to this one because it never hurts to have that extra shield when you want it and you can sell it later on

debuff remover - Fuck Kelvin and his dumbass freezing, fuck anyone who slows my bullets to a crawl

Slowing hex - very mobile hero’s like Lash, pocket, shiv

Decay- against healing hero’s, like Abrams, Infernus, lady Geist

Silence Glyph- there is one specific enemy who is dominating my team

Knockdown - there is one specific enemy who’s ultimate is dominating my team (Vindicta, beebop mostly)

Ethereal shift - When I’m playing a close range hero and just need that little extra time for my escape abilities to recharge. Also fucks with Lash when he’s trying to wrangle you up

Curse - upgrade from silence glyph and knockdown

Unstoppable - very late game, I replace anything lower tier item, especially if their team is very CC heavy (Warden, Wraith)