Dutch Heart Failure Knowledge Scale Research Articles

Disparities in 30-Day Readmission Between Medicare/Medicaid and Private Insurance Among Patients With Heart Failure Screened for Cognitive Impairment.

Racial disparities exist among patients with heart failure (HF). HF is often comorbid with cognitive impairment. Appropriate self-care can prevent HF hospital readmissions but requires access to resources through insurance. Racial differences exist between insurance types, and this may influence the disparity between races and patients with HF and cognitive impairment. The objectives of this study were to examine the relationships between insurance type and self-care stratified by race and to assess for differences in time-to-30-day readmission among patients with HF with cognitive impairment. This is a secondary analysis of data collected among hospitalized patients with HF with cognitive impairment. Patients completed surveys on self-care (Self-Care of Heart Failure Index), HF knowledge (Dutch Heart Failure Knowledge Scale), depression (Geriatric Depression Scale), and social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory). Socioeconomic data were collected. Linear models were created to examine the relationships between insurance type and self-care by race. Kaplan-Meier curves and Cox regression were used to assess readmission. The sample of 125 patients with HF with cognitive impairment was predominantly Black (68%, n = 85) and male (53%, n = 66). The sample had either Medicare/Medicaid (62%, n = 78) or private insurance (38%, n = 47). Black patients with HF with cognitive impairment and private insurance reported higher self-care confidence compared with Black patients with HF with cognitive impairment and Medicare/Medicaid (P < .05). Medicare/Medicaid was associated with a higher frequency of 30-day readmission and a faster time-to-readmission. Patients with HF with cognitive impairment and Medicare/Medicaid insurance reported lower self-care confidence and more likely to be readmitted within 30 days.

Mediators of the Association Between Cognitive Function and Self-care Behaviors in Patients Hospitalized With an Exacerbation of Heart Failure

Background Patients with heart failure (HF) must engage in self-care, yet their self-care is often poor. Cognitive function commonly is impaired in HF and is associated with poor self-care. Heart failure knowledge and self-care confidence also are needed to preform self-care. Few investigators have examined mediators of the association of cognitive function with self-care. Objectives The aim of this study was to determine whether HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance and management among patients with HF. Methods This was a cross-sectional observational study of 164 patients with HF. Cognitive function was assessed using the Montreal Cognitive Assessment. Self-care maintenance and self-care management behaviors and self-care confidence were measured using the Self-care of Heart Failure Index. Heart failure knowledge was measured using the Dutch Heart Failure Knowledge Scale. We conducted 2 parallel mediation analyses using the PROCESS macro in SPSS, one for self-care maintenance and one for self-care management. Results Cognitive function was indirectly associated with self-care maintenance through HF knowledge (indirect effect, 0.54; 95% confidence interval, 0.10–1.02) and self-care confidence (indirect effect, 0.26; 95% confidence interval, 0.04–0.54). Those with better cognitive function had more HF knowledge and self-care confidence. Better cognitive function was not directly associated with self-care management but indirectly associated with better self-care management through higher self-care confidence (indirect effect, 0.50; 95% confidence interval, 0.04–1.05). Conclusions Both HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance, and only self-care confidence mediated the association between cognitive function and self-care management. Interventions targeting HF knowledge and self-care confidence may improve self-care even for those with lower cognitive function and need to be developed and tested.

A Pre-Post, Mixed-Methods Study to Pilot Test a Gamified Heart Failure Self-Care Education Intervention.

Objective: Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours (maintenance, management and confidence), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.

Impact of behavioral health education interventions on knowledge, adherence to treatment, and quality of life of patients with heart failure: A randomized controlled trial

Heart failure (HF) is a common chronic disease with high morbidity and mortality rates. Besides HF treatments aimed to improve patients’ quality of life and health status, health education interventions for behavioral changes ensuring their adherence to treatment are very important. Therefore, this study aimed to evaluate the effect of behavioral health education interventions on knowledge, treatment adherence, and quality of life of patients with HF. This was a randomized controlled trial. A total of 330 patients were selected and randomly distributed into intervention and control groups (n = 165 per group). Data were collected at the time points before the intervention and three months after the intervention using the Dutch Heart Failure Knowledge Scale (DHFKS), Revised Heart Failure Compliance Scale (RHFCS), and quality of life (EQ-5D-5L v2.1, Vietnamese version). There were no significant differences between the two groups in HF knowledge or quality of life at baseline. After three months of health education intervention, intervention group significant increase to 1.68 times (95%CI: 1.05 – 2.69; p=0.03) in overall HF knowledge; 1.91 times (95%CI: 1.25 – 2.92; p=0.003) in general HF knowledge and 1.59 times (95%CI: 1.03 – 2.45; p=0.038) in behavior of exercise when compare to control group. However, the quality of life did not change significantly after the intervention. Although the health education intervention had no impact on the quality of life of patients with HF, it was effective in improving their HF knowledge and treatment adherence.

The Effect of Mobile Health Applications on the Knowledge of Patients of Heart Failure

Background: A lack of knowledge among patients of heart failure represents a significant problem that could lead to an increase in adverse outcomes, such as lengthening the hospitalization period and increasing the readmission rate. Purpose: This study aimed to identify the effect of mobile health education applications on the knowledge of patients of heart failure and identify the associated factors that would contribute to patients’ knowledge of heart failure. Methods: A quasi-experimental design (two groups with pretest-posttest design) was used. A non-probability convenient sample of 160 patients was recruited. The participants were assigned randomly to an experimental group and a control group. The Dutch Heart Failure Knowledge Scale was used to assess the patients’ level of knowledge. Descriptive statistics, independent t-test and multiple-regression analysis were used to analyze the data. Results: The total number of participants was 126. The overall Jordanian patients’ level of knowledge regarding the non-pharmacological management of heart failure was moderate (M = 9.4, SD = 2.07). Significant differences between study groups were found in terms of levels of knowledge. The intervention group (M = 12.26, SD = 2.36) had significantly higher mean scores of knowledge level of heart failure compared to the control group (M = 9.76, SD = 2.01); t = 6.361, p = 0.000). The result of the regression analysis was significant (adjusted R2 = 0.222, F (16,109)= 3.226, P=0.000). Conclusion: Mobile health education could be a promising solution for managing different chronic diseases, particularly HF. Implications for Nursing: Mobile health could be a more costeffective approach to patient education than other traditional approaches recently applied in clinical practice. Keywords: Heart failure, Patient education, Knowledge, Telehealth, Mobile health applications.

Relationship between Disease Knowledge and Self-care Adherence among Heart Failure Patients at King Abdulaziz University Hospital

Backgrounds: Heart failure (HF) is a progressive syndrome characterized bycomplicated therapeutic regimens and repeated hospitalizations. HF has turnedinto a global epidemic demonstrating serious mortality and morbidity. This studyaimed to assess the relationship between disease knowledge and self-careadherence among adult HF patients at King Abdulaziz University Hospital (KAUH).Methods: A cross-sectional descriptive correlational design was utilized. Patientswere recruited from outpatient clinic at KAUH in Jeddah, Saudi Arabia. Aconvenience sample of 208 HF patients. The Dutch Heart Failure Knowledge Scale(DHFS) and the European Heart Failure Self-Care Behavior Scale (EHFSCBs) wereused to measure the main study outcomes. Participants were recruited from heartfailure outpatient clinics at KAUH from January 31 – May 17, 2021. Results: 63.9%of participants were male, 49% were over 61 years old, and 30.8% of theparticipants were not educated. 55.8% of the participants had an adequate level ofknowledge about HF disease and 57.2% had a good level of self-care adherence. Themean total HF knowledge score DHFS was 8.58±3.08 out of 15 and the self-careadherence score EHFSCBs was 28.97 ±5.61out of 60. A significant positive moderatecorrelation existed between disease knowledge and self-care adherence.Conclusion: Disease knowledge was adequate in more than half of the participants,and self-care adherence was good. This study has shown a relationship betweendisease knowledge and self-care adherence, which means that a high level of HFknowledge was associated with improved self-care adherence.

Heart Failure Knowledge, Symptom Perception, and Symptom Management in Patients With Heart Failure.

Prevention of heart failure (HF) exacerbations requires that patients carefully self-manage their condition. Symptom perception is a key component in self-care for patients with HF that involves monitoring for HF symptoms and recognizing symptom changes. Heart failure knowledge is a prerequisite for better symptom perception and symptom management. However, the relationships among HF knowledge, symptom perception, and symptom management remain unclear. The aim of this study was to explore the inter-relationships among HF knowledge, symptom monitoring, symptom recognition, and symptom response in patients with HF. We included 185 patients with HF in this study. Heart failure knowledge was measured using the Dutch HF Knowledge Scale. Symptom monitoring, symptom recognition, and symptom response were measured using the Self-care of HF Index. Structural equation modeling was used for data analyses. Heart failure knowledge was associated with symptom monitoring (β = .357, P < .001). Symptom monitoring was directly associated with both symptom recognition (β = .371, P < .001) and symptom response (β = .499, P < .001). Symptom recognition was directly associated with symptom response (β = .274, P < .001). Heart failure knowledge was not directly associated with symptom recognition, nor with symptom response. Heart failure knowledge was indirectly associated with symptom recognition and symptom response through symptom monitoring. Symptom monitoring is associated with both symptom recognition and symptom response and is a mediator between HF knowledge and symptom recognition and between HF knowledge and symptom response. This finding suggests that it is important for clinicians not just to increase patients' HF knowledge but also to enhance their skills of symptom monitoring and symptom recognition and promote symptom monitoring among patients to improve symptom response in self-care.

Development and Piloting of a Community-Partnered Heart Failure Training Course for Home Health Care Workers.

Despite their unique contributions to heart failure (HF) care, home healthcare workers (HHWs) have unmet educational needs and many lack HF caregiving self-efficacy. To address this, we used a community-partnered approach to develop and pilot a HF training course for HHWs. We partnered with the Training and Employment Fund, a benefit fund of the largest healthcare union in the United States, to develop a 2-hour virtual HF training course that met HHWs' job-specific needs. English and Spanish-speaking HHWs interested in HF training, with access to Zoom, were eligible. We used a mixed methods design with pre/postsurveys and semi-structured interviews to evaluate the course: (a) feasibility, (b) acceptability, and (c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale range 0-100]). Of the 210 HHWs approached, 100 were eligible and agreed, and 70 enrolled. Of them, 53 (employed by 15 different home care agencies) participated. Posttraining data showed significant improvements (pretraining mean [SD] versus posttraining mean [SD]; P value) in HF knowledge (11.21 [1.90] versus 12.21 [1.85]; P=0.0000) and HF caregiving self-efficacy (75.21 [16.57] versus 82.29 [16.49]; P=0.0017); the greatest gains occurred among those with the lowest pre-training scores. Participants found the course engaging, technically feasible, and highly relevant to their scope of care. We developed and piloted the first HF training course for HHWs, which was feasible, acceptable, and improved their HF knowledge and caregiving self-efficacy. Our findings warrant scalability to the workforce at large with a train-the-trainer model.

Abstract 9048: Heart Failure Training Course for Home Health Aides in New York City: A Mixed Methods Pilot Study

Introduction: Although home health aides (HHAs) often care for adults with heart failure (HF), studies have found that the majority have not received HF training and lack confidence with HF caregiving. To address this, we tested the feasibility, acceptability, and effectiveness of a virtual HF training course for HHAs. Methods: We partnered with the Education Fund of the 1199SEIU United Health Care Workers East, the largest healthcare union in the US, which provides training to 55,000 HHAs in NYC. HHAs typically receive in-person training, but due to COVID-19, we conducted this course virtually. The 2-hour course, taught in English and Spanish, utilized case-based learning and motivational interviewing to engage HHAs in interactive discussions on HF signs, symptoms, and HF self-care. HHAs with access to Zoom (via smartphone, computer, or tablet) were eligible. We conducted pre/post surveys and semi-structured interviews. Measures included: a) feasibility (attendance, retention), b) acceptability (modality, technological ease, satisfaction); and c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale, range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale, range 0-100]). Results: 48 HHAs employed by 15 distinct home care agencies enrolled and completed the course; course size ranged from 4-9 participants. The majority were middle-age women (60% Hispanic, 10% non-Hispanic Black). To participate, 59% used a smartphone, 32% a computer, and 10% a tablet. Compared to prior in-person courses, 83% participants reported that the course ran more smoothly and was more convenient; only 7% reported technical problems. Participants and course instructors reported high levels of satisfaction and engagement. Post-course data showed significant and clinically meaningful improvements in HF knowledge (11.21 [1.90] v. 12.21 [1.85]; p = 0.0000) and HF caregiving self-efficacy (75.21 [16.57] v. 82.29 [16.49]; p = 0.0017). Conclusions: A virtual HF training course was feasible and acceptable among HHAs and improved their HF knowledge and caregiving confidence. Efforts to scale and disseminate the course may be warranted. Future studies are needed to test the effect of the course among HHAs and their patients.

Knowledge of heart failure patients about the disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Despite all the technological advances that have made it possible to increase the life expectancy of patients with Heart Failure (HF), this continues to be a disease with an important socioeconomic impact and high hospital mortality. Education to understand HF and the development of capacities for selfcare are considered keys to improve adherence, avoid decompensation crises and maintain the clinical stability. Purpose Evaluate the knowledge of patients with HF about the disease, treatment, symptoms and its recognition. Methods Was developed a quantitative, cross-sectional, descriptive and correlational study. The questionnaire incorporated Dutch Heart Failure Knowledge Scale (DHFKS). Sampling was consecutive non-probability of patients followed in outpatient visit and hospitalized in the ward at a university hospital. Results All elements of the sample answered that "it is important that I take my HF medication regularly". It is important to understand that adherence to therapy is not just taking medications, but also complying with the diet and modification habits or lifestyles. The item that followed with the highest correct rate (97%) was the one that questions what the meaning of HF is. The patient should be tried to understand the cause of the HF, the symptoms and the course of the disease and based on that, make realistic decisions, including decisions about treatment at the end of life. When asked about the best thing to do in case of increased dyspnea or edema, 90.7% know that early contact with the doctor or nurse is important. The patient must be able to monitor and recognize changes in signs and symptoms so that understands when and how to contact a health professional. The nursing intervention should focus on educating patients and their families for the early recognition of these signs and symptoms, avoiding episodes of decompensation. One of the items with the worst correct rate was "How often should patients with severe HF be weighed?" (37.2%). Daily weight have an important role in identifying signs of hypervolaemia. The other item with the worst correct rate was "Why should a patient with HF follow a low-salt diet" (34.9%). The knowledge of the patients in our sample needs to be probed about the area of food, particularly with the salt restriction and daily weight control. However, they recognize the importance of taking the medication and what to do in case of worsening symptoms. Conclusions We can conclude that about knowledge, patients recognize the importance of taking their medication on a regular basis, they know what "HF" means, what to do in case of dyspnea or edema and what diuretics are for. Instead, they have difficulty understanding the need to weigh themselves daily and the importance of reducing salt in them diet. With this study, it is concluded that it is important to invest in the education of patients and their families so that they adopt healthy lifestyles that can increase their life quality.

Self-management on heart failure: A meta-analysis

Background and aimsHeart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. MethodsThe research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. ResultsEight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. ConclusionSelf-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).

TURKISH VERSION OF THE DUTCH HEART FAILURE KNOWLEDGE SCALE: VALIDITY AND RELIABILITY

Objective: To determine the validity and reliability of the Turkish version of the Dutch Heart Failure Knowledge Scale. Methodology: The cross sectional study was composed of patients who were followed up in cardiology clinics of a university hospital in Malatya. Consecutive patients were enrolled in the study. Data were collected using Dutch Heart Failure Knowledge Scale, along with a questionnaire regarding demographic properties. The scale consisted of 15 items, and every item was scored as either 0 or 1. Confirmatory Factor Analysis and Exploratory Factor Analysis were applied to assessed the Scale validity. Results: Dutch Heart Failure Knowledge Scale reliability was assessed with Cronbach’s alpha internal consistency coefficient, item-total score correlation, and test-retest analysis, which ranged between 0.70-0.82, 0.54-0.86, and 0.30-0.52, respectively. Conclusion: The results of Confirmatory Factor Analysis and Exploratory Factor Analysis supported the single factor scale structure and Confirmatory Factor Analysis yielded good fit indices. The Dutch Heart Failure Knowledge Scale Turkish version is valid, reliable.

Determination of Knowledge and Self Care Behavior of Heart Failure Pateints According to Orem Theory

Background: Heart failure (HF) is a chronic disease that requires special lifelong self-care behaviors. These patients need having self-care behaviors to confront their disease problems. Aim of the study: To assess patient knowledge about heart failure and determine the self-care behavior of heart failure patients. Subject and methods: To conduct this study, a descriptive research design was utilized. Sample: a convenient sample of 60 patients with heart failure. The study was conducted in coronary care unit at Abou-tig central hospital. Tools: One tool was utilized to collect data for this study: Patient interviewing questionnaire sheet including three parts: Part (1) demographic characteristics of the patients, part (2): Dutch heart failure knowledge scale, part (3) Heart failure self-care behavior scale, Results: The majority of the studied patients (75%) had unsatisfactory knowledge levels, while the minority (26.7%) of them had good self-care behavior. Conclusion: The majority of the studied patients had unsatisfied level of knowledge about heart failure and had poor self-care behavior. Recommendation: patients with heart Failure are in pressing need for health education about their illness which will reflect on their self-care behavior and results in better quality of life

Knowledge regarding Heart Failure: A Reflection on Current Disease Knowledge State among Iranian Patients with Heart Failure

Background: Heart failure (HF) is a serious problem with an increasing prevalence globally. Low level of HF knowledge may cause low compliance and low quality of life and, poor self-care. On the other hand, assessing the level of HF knowledge is necessary in order to apply educational programs. Aims and objectives: the aim was to determine knowledge regarding HF among Iranian patients with HF. Study Design: This was a cross sectional study. Setting: We conducted this study at the HF clinic of Tehran Heart Center (THC) affiliated with Tehran University of Medical Sciences (TUMS, Tehran, Iran). Materials and Methods: In this cross-sectional study, 190 patients older than 18 years old, with confirmed diagnosis of HF for at least 3 months by an HF specialist, NYHA function class II to IV and an ability of reading and writing Farsi language were included during June 2017 and January 2018 by consecutive sampling. Data were gathered in a short form, including demographic and clinical variables. Knowledge regarding HF was measured by the Dutch HF knowledge scale (Cronbach’s alpha=0.62) with 15- multiple choice item. The score range varied between 0 (no knowledge) and 15 (optimum knowledge). Scores were reported totally and in 3 areas of knowledge. Scores higher than the median was considered as higher knowledge. Statistics: The SPSS software version 16 was used to describe data. Normality of continuous variables was checked by the Kolmogorov-Smirnoff test. Frequency and partial frequency distribution were used to describe Categorical variables. While, we used mean, median, standard deviation, and IQR for describing continuous variables. Results: From June 2017 to January 2018, 160/190 patients with median age (IQR) of 59 (16) years old participated in the study (response rate of 84.2%). 67.5% of study patients were male (83.5%). 87.5% of then were married. The majority of patients were with NYHA function class II (60.6%), and with an etiology of ischemic heart disease (65.0%). The median and IQR of total, general, HF treatment, and symptoms/ symptom recognition knowledge were 8 (7-10), 12 (9-14), 2 (1.25-3), and 4 (3-5), respectively. Low level of total, general, HF treatment, and symptoms and symptom recognition knowledge among Iranian patients with HF were 55%, 60%, 58.8%, and 71.9%, respectively. Conclusion: Patients with HF had low levels of total, general, HF treatment, and symptoms/symptom recognition knowledge. Thus, there is an essential need to be improved by an appropriate intervention, especially on knowledge of symptoms /symptom recognition.

Factors Affecting Self-care Maintenance and Management in Patients With Heart Failure: Testing a Path Model.

Self-care is indispensable for health maintenance and well-being. This naturalistic decision-making process involves behavioral choices to maintain physiological stability (self-care maintenance) and response to occurring symptoms (self-care management). However, several factors affect self-care, but some have contradictory results. We aimed to examine how depressive symptoms, social support, eHealth literacy, and heart failure (HF) knowledge directly and indirectly affect self-care maintenance and management and to identify the mediating role of self-care confidence in self-care maintenance and management. The study included a total of 141 patients with HF (average age, 65.2 years; male, 55.3%). We analyzed their data, including demographic and clinical characteristics, obtained from the Patient Health Questionnaire-9, Multidimensional Scale of Perceived Social Support, eHealth Literacy Scale, Dutch Heart Failure Knowledge Scale, and Self-Care of Heart Failure Index. Furthermore, path analysis was conducted to examine the effects of the study variables on self-care maintenance and management. Self-care confidence significantly and directly affected self-care maintenance and management and mediated the relationships between factor variables (depressive symptoms, social support, and HF knowledge) and outcome variables (self-care maintenance and management). Specifically, depressive symptoms had a negative and direct effect on self-care maintenance, whereas eHealth literacy had significant and direct effects on self-care management and HF knowledge. Self-care confidence decreases the negative effects of depressive symptoms on self-care. This study underscores the need for interventions targeting patients' self-care confidence to maximize self-care among patients with HF.

Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting

Aims Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. Methods This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. Results Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower (p = 0.07) in telemonitoring. Conclusion In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure

Background: Heart failure affects more than 6 million Americans and an estimated 23 million people worldwide. Inadequate self-care is associated with readmissions and are identified as a marker for poor health outcomes. Nurse-led heart failure inpatient hospital education has been demonstrated to improve knowledge, self-care behaviors and in some studies to reduce 30-day readmissions.Aims/Objectives: To evaluate the impact of nurse-led heart failure patient education on knowledge, self-care behaviors, and all cause 30-day hospital readmission.Design: Quasi-experimental pre-test and post-test on a convenient sample on two cardiac units at a large urban facility in the North East region of the United States.Methods: An evidence-based standardized heart failure patient education program based on the American Colleges of Cardiology and American Heart Association guidelines was implemented with a telephone follow-up at 7, 30, and 90 days post-discharge. The duration of the study was from September 2015 to February 2016. A convenience sample of (N = 29) individuals diagnosed with heart failure was asked to complete Dutch Heart Failure Knowledge Scale and Self-care Heart Failure Index.Results: A significant difference was found in knowledge at 7 day (P ≤ .001) and 90 day (P ≤ .032), self-care maintenance at 7 day (P ≤ .000) and 30 day (P ≤ .000), self-care management at 7 day (P ≤ .001) and 30-day (P≤.013). A statistically significant difference was found in self-care confidence at 30-day (P ≤ .017) but not at 7 day follow-up call. A statistically significant improvement in 30-day readmission was not found (P ≥ .05).Conclusion: Findings suggest the importance of developing patient education programs that are focused on improving knowledge and self-care behaviors for heart failure patients. Nurses are uniquely qualified to implement such programs that can improve health outcomes and need to accommodate evidence-based recommendations to global practice settings.

Knowledge about heart failure and self-care persists following outpatient programme- a prospective cohort study from the Faroe Islands

ABSTRACT Objectives: Longer life expectancies imply increased prevalence of heart failure. Blittle is known about the maintenance of disease specific knowledge following patient education. Our aim was to investigate if self-care and heart failure knowledge persists at 9 month follow up among patients with heart failure after an outpatient programme in the Faroe Islands. Methods: A prospective cohort study with patients recently diagnosed with heart failure were recruited and evaluated by questionnaire at baseline, after 3 and 9 months using The European Heart Failure Self-Care Behaviour Scale and the Dutch Heart Failure Knowledge Scale. Clinical and demographic information was collected. Results: Seven (15%) women and 40 (85%) men with heart failure and NYHA > 2 were included. There was an overall improvement in patients’ self-care from baseline 25 (8) to 3 months 15 (5) and to 9 months (16 (45); both p < 0.001). Mean knowledge score 10 (3) improved to 13 (2) at 3 months and 12 (2) at 9 months (both p < 0.001). Conclusions: Disease specific patient education is applicable to heart failure patients, which can produce persistent improvements in self-care and knowledge after multidisciplinary outpatient programme. Practice Implications: Multidisciplinary outpatient programmes are beneficial for patients with heart failure and alters disease specific knowledge and self-care.

Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study.

AimsThere are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio‐economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio‐economic factors were associated with patient‐reported outcome measures (PROMs).Methods and resultsIn this cross‐sectional survey, PROMs were measured with seven validated instruments, as follows: self‐care (the 12‐item European Heart Failure Self‐Care Behaviour scale), HF‐related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care—‘Patients' evaluation’), health status (EQ‐5D visual analogue scale), health‐related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status.The patients' (n = 124, mean age 73 ± 14.9, 69% male) self‐care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF‐specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1–6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ‐5D) on average at 65.5 (scale 0–100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care‐related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out‐of‐pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out‐of‐pocket expenses after the crisis, income, or whether patients lived alone or with others.ConclusionsThis Icelandic patient population reported similar health‐related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

IMPACT OF HEALTH LITERACY ON KNOWLEDGE, SELF-CARE AND CLINICAL OUTCOMES IN HEART FAILURE PATIENTS

The purpose of this study was to identify the prevalence of low health literacy (HL) and to determine whether low HL contributes to poorer disease knowledge, self-care, and clinical outcomes in ambulatory patients with heart failure (HF). We enrolled 147 English-speaking patients from our ambulatory HF clinics between January 2015 and February 2016. HL was measured with the Newest Vital Sign, knowledge with the English-version Dutch Heart Failure Knowledge Scale, and self-care with the Self-Care Heart Failure Index. Information on mortality, hospitalizations, heart transplant (HT) or left ventricular assist device (LVAD) implant were collected over two years. Primary analysis was multivariable linear or univariable logistic regression. Level of significance for all tests was pre-set at 0.05. The sample was predominantly male (73.1%) with an average age of 56.8 ± 14 years. 44 (30.3%) had low HL. Patients with low HL were significantly older (56.8 vs 54.4 years) had less formal education (47.7% vs 75.2% post-secondary), and spoke English as a second language (40.9% vs 15.8%). Patients with low HL had lower HF knowledge scores (10.8 vs 12.5). There were no significant associations between HL and self-care scores. At 18 months the risk of death, HT or LVAD was 3% for patients with adequate HL versus 24% for low HL (OR 0.28; 95% CI: 0.10-0.78, p<0.05). This study found that 30% of patients with HF have low HL. Low HL is characterized by increased age, less formal education, and English as a second language. Patients with low HL had worse outcomes at 18 months despite no difference in self-reported self-care measures.