Clinical Outcomes After Viewing Video Education on Danger Signs and Symptoms of Worsening Heart Failure and Self-care Actions

Abstract

Background Patients with heart failure (HF) must understand subtle escalation in fatigue, dyspnea, and edema before they are triggered to control worsening status. Objective The aim of this paper is to examine if video education of HF danger signs or symptoms recognition and control, developed using symbolic modeling (social cognitive theory), leads to between-group differences in functional status, symptoms, and self-efficacy for managing symptoms at 30-days, all-cause, and HF-related hospitalization, emergency department visits, and death at 30, 90, and 180 days. Methods Using a 2-group, randomized controlled, multicenter, single-blind design, patients received video education (VE) plus usual care (UC) or UC alone before hospital discharge. VE patients also had access to content post discharge. Thirty-day functional status, fatigue, dyspnea, and self-efficacy for managing symptoms were assessed using valid, reliable tools. In the analysis, multivariable models were created to compare changes in patient-reported outcomes from baseline to 30-days post discharge and morbidity or mortality outcomes up to 180 days. Results Of 369 VE and 377 UC patients enrolled from 7 sites, mean age was 68.0 (SD 12.4) years, and 206 (55.9%) were male. At 30 days, there were no between-group differences in the change in functional status, fatigue, dyspnea, and self-efficacy from baseline. In multivariable analyses, between-group outcomes did not differ at 30 or 90 days. At 180 days, HF-related events and HF-related hospitalization were higher in the video group—odds ratios (95% CI): 1.42 (1.04, 1.94), P=.03; and 1.44 (1.05, 1.97), P=.03, respectively. In time-to-event adjusted analyses, video patients had earlier HF-related hospitalization, compared to UC patients—hazard ratio (95% CI) 1.32 (1.02, 1.72), P=.04. Conclusions Video education on recognition and control of danger signs or symptoms paradoxically increased HF-related events and hospitalization and decreased time to first HF-related hospitalization. Increased recognition of subtle HF signs or symptoms via video education is valuable but must be connected to patient or family self-care actions that reduce HF signs or symptoms. Trial Registration ClinicalTrials.gov NCT03657459; https://clinicaltrials.gov/ct2/show/NCT03657459 Conflicts of Interest None declared.