Heart Failure Patient Education Research Articles

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.

Clinical Perspectives on the Development of a Gamified Heart Failure Patient Education Web Site.

Heart failure is a complex, chronic disease that requires self-care to manage, and patients need support and education to perform adequate self-care. Although electronic health interventions to support behavior change and self-care in cardiovascular disease are gaining traction, there is little engaging online education specifically designed for heart failure patients. This paper describes the design and development of a heart failure self-care patient education Web site that integrated gamification, meaning the use of game design elements in a non-game context. We sought feedback on the Web site from a group of heart failure clinicians in a focus group using a semi-structured interview guide, and data were analyzed thematically. Clinician input during the design phase touched on themes such as patients' decision-making in heart failure and older adults' adoption of technology. Clinicians recommended that a narrative gamification technique should reflect real-life dilemmas patients encounter in their self-care. Clinicians also discussed the need to carefully plan reward-based gamification techniques to avoid unintended effects. Overall, a gamified Web site has the potential to support heart failure self-care, but efforts are needed to address the disparity of those with limited computer literacy or access.

What kind of patient education and self-care support do patients with heart failure receive, and by whom? Implementation of the ESC guidelines for heart failure in three European regions

BackgroundIn order to manage Heart Failure (HF) properly, both pharmacological and non-pharmacological interventions including patient education and self-care (SC) support are important. Appropriate health care (HC) professional support is necessary to improve patient SC-skills. However, little is known which HC-professionals deliver specific education and support in daily HF-care. ObjectivesTo describe patient-education and SC-support as perceived by different HC-professionals in three neighboring North-West European regions: Maastricht(the Netherlands), Noorder-Kempen(Belgium), Aachen (Germany). MethodsSemi-structured interviews with cardiologists, HF-nurses and general practitioners (GPs) were performed, followed by qualitative content analysis with a five-step approach: 1) familiarization with data, 2) initial coding with an a-priori code manual, 3) structuring of data in main themes, 4) revision and recoding of initial codes and 5) synthesizing codes in main themes. ResultsThe sample consisted of 15 cardiologists, 35 GPs and 8 HF-nurses. All interviewed HC-professionals provide HF patient-education, yet, the extent differs between them. Whereas HF-nurses identify patient-education and SC-support as one of their main tasks, physicians report that they provide little education. Moreover, little patient education takes place in primary care; with almost none of the GPs reporting to educate patients about SC. GPs in region 2 refer HF-patients to their practice nurse for education and SC-support. None of the HC-professionals reported to provide patients with all key-topics for patient education and SC-support as defined by the ESC. ConclusionHF nurses consider patient-education and SC-support as one of their main tasks, whereas physicians pay limited attention to education. In none of the three regions, all recommended topics are addressed.

Frailty and predictive factors in Chinese hospitalized patients with heart failure: a structural equation model analysis.

Frailty is closely related to the prognosis and quality of life of patients with heart failure (HF). However, the predictors of it are still unclear. Our study aimed to describe the frailty status of Chinese hospitalized patients with HF and explore predictive factors guided by Theory of Unpleasant Symptoms. In this cross-sectional descriptive study, questionnaire-based survey was conducted among 323 patients hospitalized with HF in three tertiary hospitals in Wuhan, China. Frailty was measured by the Tilburg Frailty Indicator (TFI) in this study. The model based on Theory of Unpleasant Symptoms fits the sample well (root mean square error of approximation = 0.063, goodness of fit index = 0.977, normed fit index = 0.901, and comparative fit index = 0.940). Frailty among Chinese patients hospitalized with HF was at high level (TFI = 6.57 ± 3.05). General demographic characteristics (older age, female gender, lower education level, and medical payment method), physical factors (higher New York Heart Association cardiac function class), psychological factors (more severe depression), and social factors (poorer social support) were significant predictors of more severe frailty (P < 0.05). Depression played an important mediating role in this study. Theory of Unpleasant Symptoms can be used to guide the research on the frailty of HF patients. It is suggested to strengthen emotional support and health education for HF patients in China. In addition, more attention should be paid to the less educated population by providing more personalized health guidance.

Psychometric Validation of the Korean Version of the Heart Failure-Specific Health Literacy Scale.

The goals of heart failure (HF) management include lowering adverse outcomes through optimal self-care. Health literacy has a significant role in ensuring optimal and effective HF self-care. Unfortunately, the proportion of low health literacy in HF patients is higher than those with other chronic diseases as well as the general population. Thus, healthcare providers need to screen HF patients. The HF-Specific Health Literacy Scale is a specific questionnaire to screen the health literacy in HF patients; however, the Korean version has not yet been validated. The study aimed to investigate the reliability and validity of the Korean version of the HF-Specific Health Literacy Scale. We adopted a cross-sectional study design with 386 outpatients with chronic HF from a tertiary care hospital in Cheonan, South Korea. Data were collected from April to December 2020. The exploratory factor analysis revealed a three-factor (functional, communicative, and critical health literacy) 12-item structure of the scale. The result of the confirmatory factor analysis confirmed a good statistical fit for the data. The Korean version of the tool demonstrated satisfactory convergent and discriminant validity. The criterion validity analysis revealed significant correlation with general health literacy and knowledge about HF. The Korean version of the tool for 12 items had adequate overall internal consistency. The Korean version of the HF-Specific tool can be easily utilized for assessing health literacy level for HF patient education. Moreover, the tool can help healthcare providers develop strategies for promoting HF patients' health literacy.

Get with The Guidelines and Guideline Directed Medical Therapy: Why it Matters

Despite therapeutic advances, the epidemic of heart failure (HF) is as challenging as ever. Gaps in prescribing, dose intensification, and adherence leave the vast majority of patients on suboptimal treatment regimens. Without a serious commitment to improving processes of care, many of the scientific advances now available to patients with HF are lost. The tools of process improvement bring operational processes and medical evidence together through guidelines, data standards, quality metrics and performance measures, national registries and benchmarking. Participation in national clinical registries/quality improvement programs offers a method for accurately assessing processes and outcomes and offers feedback on how individual hospital and clinician practices compare with their peers through benchmarking performance against aggregate national or similar hospital outcomes following adjustment for case mix. These quality improvement programs also help share and disseminate best practices and process improvement techniques that can be tailored and implemented locally. A notable example of a national clinical registries/quality improvement program in HF is the American Heart Association's Get With The Guidelines. GWTG-HF is an in-hospital program for improving care by promoting consistent adherence to the latest scientific treatment guidelines. Hospitals participating in GWTG-HF have been able to achieve and sustain high rates of use of the full set of guideline-directed medical therapies, along with provision of HF patient education. Quality of care and clinical outcomes for participating hospitals have been shown to be superior to that of comparable hospitals not participating. It is estimated that if process improvement for HF treatment were implemented optimally more than 100,000 lives a year of HF patients in US each could be saved. Despite therapeutic advances, the epidemic of heart failure (HF) is as challenging as ever. Gaps in prescribing, dose intensification, and adherence leave the vast majority of patients on suboptimal treatment regimens. Without a serious commitment to improving processes of care, many of the scientific advances now available to patients with HF are lost. The tools of process improvement bring operational processes and medical evidence together through guidelines, data standards, quality metrics and performance measures, national registries and benchmarking. Participation in national clinical registries/quality improvement programs offers a method for accurately assessing processes and outcomes and offers feedback on how individual hospital and clinician practices compare with their peers through benchmarking performance against aggregate national or similar hospital outcomes following adjustment for case mix. These quality improvement programs also help share and disseminate best practices and process improvement techniques that can be tailored and implemented locally. A notable example of a national clinical registries/quality improvement program in HF is the American Heart Association's Get With The Guidelines. GWTG-HF is an in-hospital program for improving care by promoting consistent adherence to the latest scientific treatment guidelines. Hospitals participating in GWTG-HF have been able to achieve and sustain high rates of use of the full set of guideline-directed medical therapies, along with provision of HF patient education. Quality of care and clinical outcomes for participating hospitals have been shown to be superior to that of comparable hospitals not participating. It is estimated that if process improvement for HF treatment were implemented optimally more than 100,000 lives a year of HF patients in US each could be saved.

Abstract 10698: Towards a Dialogue Agent to Assist African American and Hispanic/Latino Heart Failure Patients with Dietary Restrictions

Background: Restricting dietary sodium is a common recommendation to address symptoms in heart failure (HF) patients. However, using the information provided on nutrition labels can be complex, leading to lapses in adherence. This problem is compounded by insufficient information on ethnic preferences in dietary habits. Based on our previous findings we developed a prototype dialogue agent (HF-DA) to assist African American (AA) and Hispanic Latino (H/L) patients with their HF self-care needs, including understanding nutrition labels and providing practical information per FDA recommendations. Objective: Compare HF-DA against existing technology in the public domain in assisting AA and H/L HF patients to make healthy food choices. Methods: We conducted a review of existing technology in two ways. 1: Google search engine: We measured the number of actions (typing, scrolling, clicking) required to find a source for a food’s sodium content matching the U.S. Department of Agriculture’s recommendations and used a calculator to understand the total sodium in a desired serving size. We identified relevant search terms by analyzing the commonly used words in the transcripts from our HF patient education sessions with their health educators (18 AA and 2 H/L) and 1:1 interviews with HF patients (3 AA and 1 H/L). 2: Google Play Store: We downloaded the top 15 apps using the search term “heart failure” and explored their functionality. Results: Google’s search engine required users to perform 1 action to identify the sodium content and percent daily value but then needed 6-8 actions (dependent on query length) to calculate sodium content of total serving size. Our HF-DA provides this information in 4 actions. Of the 15 apps available in the Play Store, none had any features for understanding nutrition labels. Conclusion: Our preliminary analysis revealed there are very few culturally sensitive technological resources available to assist HF patients in understanding nutrition labels. These resources require a patient to understand nutrition labels, perform arithmetic, and recall dietary restrictions. HF-DA is capable of promoting healthy eating habits by aiding HF patients' decision-making process by providing reliable information in fewer steps.

P016. Evaluating the Efficacy of Focused Nurse Practitioner Visits on Heart Failure Outcomes Among Patients Enrolled in the Program for All-Inclusive Care of the Elderly (PACE): A Quality Improvement Project

Background Symptom management in heart failure (HF) is the cornerstone to improve outcomes in this complex population. Rehospitalization rates due to HF sequelae are high and symptom management remains an ongoing issue. Focused Nurse Practitioner (NP) visits with evidence-based patient education will enhance engagement and self-care management of HF. Ultimately, this will improve HF outcomes for participants in the PACE program. Purpose The purpose of this quality improvement project was to evaluate the efficacy of focused NP visits on improving HF related outcomes among participants of the PACE program in western Florida. Methods The project was based on the Information, Motivation, Behavioral skills theoretical model with patient engagement as the key mediator to achieve improved HF self-management. The NP saw each participant twice. The first visit established baseline data through questionnaires. The second visit was to discuss the evidence-based HF patient education booklet created by this author and complete the post-intervention questionnaires. Table 1 describes the outcome measures and instruments used. The outcomes evaluated included HF knowledge, quality of life, HF self-care and symptom burden, demographic data, medical history, and clinical variables. The questionnaires used included the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Atlanta HF Knowledge Test (AHFKT), the Self-Care of HF Index questionnaire (SCHFI), the Symptom Status Questionnaire - Heart Failure (SSQ-HF). Results The results for the AHFKT were statistically significant (p = .037) indicating the evidence-based education provided was effective. The self-efficacy and knowledge portion of the KCCQ was statistically significant (p = .047) indicating the education and focused NP visits increased participant knowledge and ability to effectively manage their HF. The result of the AHFKT surmises the evidence-based education provided was effective, which is supported by the results from the KCCQ on knowledge and self-efficacy. In evaluation of the symptom severity questions, it was determined that participants were more self-aware of their HF symptoms after the HF education, thus providing responses to the KCCQ that showed an inverse relationship. Conclusion The clinical implications for this practice change indicates the evidence-based education booklet is an effective tool in the management of HF when combined with focused NP visits. The NP visits showed improved outcomes and would be beneficial to HF patients ongoing. In terms of sustainability, the evidence-based education booklet has been adopted for all HF patients.

P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life

<h3>Background</h3> Heart failure (HF) is a progressive and debilitating disease with high morbidity and mortality rates. HF affects both physical and psychosocial health with over 75% of HF patients experiencing frailty and 10-40% of HF patients having difficulty preforming activities of daily living. These limitations heavily impact healthcare related quality of life (HRQOL). Patient education has been shown to improve HF outcomes, but it remains poorly utilized. <h3>Objective</h3> This evidence-based quality improvement project aims to show that a HF education packet with nurse practitioner (NP) led reinforcement can improve HRQOL. <h3>Methods</h3> This project uses a comparison prospective design that assesses pre and post intervention scores on the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Participants had chronic heart failure and were selected from HF clinic referrals. A HF packet with educational materials focused on self-care education with reinforcement provided by NPs in the HF clinic was given to participants. Data on demographics, comorbidities, time since onset of HF, quantity of follow ups, and time between initial and post visit was collected. A KCCQ-12 was given at their initial visit and at a 3-6 month post initial visit. <h3>Results</h3> 12 participants were enrolled. KCCQ-12 domains and HRQOL metrics, including physical limitation (MD = 21.92, SD = 32.4, p = .039), quality of life (QOL) (MD = 20, SD = 26.8, p = .025), and overall summary score (MD = 14.67, SD = 18.2, p = .018). had a statistically significant improvement. Social limitations (MD = 8.08, SD = 31.1, p = NS) and symptom frequency (MD = 8.25, SD = 14.8, p = NS) had a trend towards improvement, but did not reach statistical significance. Within the reduced HF subgroup (N = 9) physical limitations (MD = 27.67, SD = 35.1, p = .038) and overall summary score (MD = 17.89, SD = 20.1, p = .028) significantly improved. Uniquely, symptom frequency (MD = 12.11, SD = 11.1, p = .011) significantly improved in the reduced HF subgroup. There was no statistically significant improvement in the preserved HF subgroup (N = 3) in any of the KCCQ-12 domains. There were no HF hospitalizations during the 3-6 month follow-up. <h3>Conclusion</h3> This project shows that a guideline driven patient education intervention that focuses on self-care via a HF packet with NP follow up to reinforce education improved overall HF HRQOL. Improvement in the KCCQ-12 overall summary score indicates improved HF outcomes such as reduced HF hospitalizations and mortality. Creating a standardized HF education packet that is readily available and can guide patients and clinicians in their HF education discussion may increase rate of HF patient education in clinics, although this study did not measure this specifically. Further studies, with larger participant base, are needed to confirm efficacy of this type of intervention in patients with HF with preserved ejection fraction. In addition, Studies with longer duration would be beneficial to assess impact on mortality.

Impact of a model of care for heart failure in-patients to reduce variation in care: a quality improvement project.

We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care. To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse-pharmacist early follow-up clinic. Outcomes were assessed using interrupted time series analyses. The pre-intervention group comprised 1585 patients, and post-intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30-day readmissions did not change in overall trend (-0.2% per month, P = 0.479) but a significant immediate step-down of 7.8% was seen (P = 0.018). For 90-day readmissions, a significant trend reduction over the time period was seen (-0.6% per month, P = 0.017) with a significant immediate step-down (-9.4%, P = 0.001). Emergency department representations, in-patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit. This model of care resulted in overall trends of reductions in 30- and 90-day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.

Abstract 16673: Empowering Heart Failure Patients Through Technology and Focused Education

Introduction: Heart Failure (HF) patient engagement after hospital discharge is key to preventing readmission and compliance. According to Medicare Hospital Compare the average rate of unplanned readmission is 21.6% Objective: The Rise Above Heart Failure™(RAHF) pilot program was created to identify strategies to reduce the burden of common HF complications and ultimately reduce hospitalization. The pilot included targeted quality improvement strategies, provider engagement, and a redesigned patient journey. Methods: Three North Texas pilot sites received quality improvement consultation and measured their progress towards improved guideline-directed care by tracking the impact to the 1,347 patients discharged with heart failure in Get With The Guidelines®-Heart Failure (GWTG-HF). The RAHF Pilot Program focused on engaging key stakeholders who working in partnership with AHA staff, developed a new patient journey for patients in the pilot. Results: The percent of HF patients who received 60 minutes of heart failure education by a qualified heart failure educator was analyzed and yielded the following results: the program hospitals saw an average adherence of 51.0% in Q2 and 53.9% adherence in Q4 (%Δ =5.8%). Additionally, the pilot program’s average of 50.47% during Q2-Q4 was more than 10% greater than the national average during the same time period. In the outpatient setting, HF PATH app users completed both a pre and post knowledge assessment between Oct 2019 - March 2020. A perfect score on the assessment is 19. The average pre-score for these participants is 16.33, while the average post-score for these participants is 17. Conclusions: Midterm results indicate that the program is successfully increasing HF patient education to increase patient awareness and understanding of HF, as represented by higher adherence to the 60 Minutes of Heart Failure Education measure and positive trends in the HF Path app knowledge assessment scores.

30-day readmission prevention program in heart failure patients (RAP-HF) in a community hospital: creating a task force to improve performance in achieving CMS target goals

ABSTRACT In 2012, Centers for Medicare and Medicaid Services (CMS) announced it would penalize any hospitals that had 30-day readmission rates for heart failure (HF) patients above 20%. Mather Hospital Northwell Health, a community teaching hospital, organized a proactive task force to meet these goals. We describe our hospital-wide Readmission Prevention in Heart Failure (RAP-HF) project. We focused on the following interventions: early identification of patients at risk for readmission, discipline-specific mitigation planning by the interdisciplinary rounding team, enhanced medication education for heart failure patients, education of family/caregivers on medication and heart failure symptoms, facilitation in scheduling of post-discharge follow up visits and hard-wired communication between hospital and post-discharge care providers. We saw a 25.53% decrease in 30-day readmission rates.

Effectiveness of an avatar educational application for improving heart failure patients' knowledge and self-care behaviors: A pragmatic randomized controlled trial.

To evaluate the effectiveness of education using avatars for improving patients' heart failure knowledge and self-care. A lack of knowledge and self-care contributes to poor outcomes and rehospitalization for people with heart failure. A multi-centred, non-blinded pragmatic randomized controlled trial. Heart failure patients were randomly assigned to intervention (avatar education application) or usual care groups. Participants were followed up at baseline, 30 and 90days. ANCOVA was used to compare the scores of heart failure knowledge and self-care, between the two groups. Fisher's exact test was used to compare the two groups' heart failure-cause readmission. Bivariate exact binary logistic regression was used to identify the predictors associated with baseline levels of knowledge. A total of 36 participants were recruited (between October 2018 - March 2019). The meanage of participants was 67.5 (SD 11.3) years. At enrolment, approximately half (47.2%) have been living with Heart Failure for over 5years. Two groups were comparable at baseline in their demographic and clinical characteristics. At 90days, the interventiongroup participants had a higher increase in knowledge score on the Dutch Heart Failure Knowledge Scales compared with the control group (22.2% versus 3.7% P=.002, partial η2 =0.262, 95% CI -2.755 to -0.686). There was no between-group difference observed at 30- or 90-day follow-up, on self-care behaviour (Self-care of heart failure index) or healthcare use. Overall satisfaction with the avatar app was 91.3%. The addition of a co-designed avatar app to usual care improved knowledge in our group of Heart Failure participants at 30days and continued to increase up to 90days. The results suggest that our avatar app was perceived as an enjoyable and engaging means of delivering critical knowledge and self-care information. Heart failure is associated with poor clinical outcomes (i.e., readmission rates and mortality rate) and substantial economic burden. The effectiveness of Heart Failure patient education using avatar have not been investigated previously. In this study, the avatar app improved knowledge and self-care behaviours. This innovation could be used at the bedside, at home by nurses, patients and families. Australian New Zealand Trial RegistryACTRN12617001403325.

Perceptions of Mobile Technology for Heart Failure Education and Self-Management Among Middle-Aged and Older Adults.

Mobile technology is a promising educational platform for chronic disease management. Patients with heart failure (HF) have high rates of hospitalization and complications. The goal of the current cross-sectional study was to determine if middle-aged and older adults were using or willing to use technology for HF education and self-management. A convenience sample of 37 patients with HF were recruited from an outpatient HF clinic. Participants were asked to complete a 23-item paper survey. Male participants comprised 59.5% of the sample and 54.1% of the sample reported being age ≥65. Most participants (60%) described using text messaging and Facebook®, 78.3% reported believing technology could help with HF management, and 70.3% of participants indicated willingness to use technology. Findings indicate that incorporating mobile technology into HF education and self-management is of interest to middle-aged and older adults. These findings have important implications for designing HF patient education programs. [Journal of Gerontological Nursing, 45(11), 30-38.].

Etiological Role of Diet in 30-Day Readmissions for Heart Failure: Implications for Reducing Heart Failure-Associated Costs via Culinary Medicine.

Background. Reducing the under-30-day readmission for heart failure (HF) patients is a modifiable quality-of-care measure, yet the role of diet in HF readmissions and cost-effective HF care remain ill-defined. Methods. Medical chart review was conducted to determine cause(s) for HF treatment failure. Randomized controlled trial-backed machine learning models were employed to assess the relationship of culinary medicine education with HF 30-day readmission rate and cost. Results. Of 1031 HF admissions, 130 occurred within 30 days of discharge (12.61%.) Nearly two-thirds of individuals were male (64.02%), while the mean age and median length of stay were 64.33 ± 14.02 and 2, respectively. Medication noncompliance (34.62%) was the most common etiology for 30-day readmissions, followed by dietary noncompliance (16.92%), comorbidity (16.92%), a combination of dietary and medication noncompliance (10%), HF exacerbation (10%), iatrogenic (10%), and drug abuse (1.54%). Medication noncompliance contributed to the highest gross charge by readmission, costing a total of $1 802 096. Compared with traditional care, culinary medicine education for HF patients would prevent 93 HF readmissions and save $3.9 million in an estimated 4-year period. Conclusion. Though pharmacological treatment remains a focal point of HF management, diet-based approaches may improve tertiary HF prevention and reduce HF-associated health care expenditures.

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.

Video Education Improves Heart Failure Knowledge and Self-Care

Background Patient education is recommended to enhance self-care in all heart failure (HF) guidelines. The optimal method of educating HF patients is not known, but video education (VE) can provide a standardized and cost-effective method to deliver HF patient education. In addition, mobile technology can be an efficient and convenient way to deliver patient education as patients transition from hospital to home. Purpose The purpose of this study was twofold: 1) Evaluate whether HF knowledge, self-efficacy, self-care skills, and readmission rates improved after adding VE to usual care, and 2) Evaluate patient satisfaction with VE. Methods A convenience sample of adult HF inpatients was recruited over 11 weeks at an academic medical center. Participants received access via tablet, smartphone, or computer to 26 videos, each between 2-4 minutes in length, and lasting a total of 1.5 hours. The first video was shown while inpatient and subsequent videos were viewed at participants’ discretion while inpatient as well as after discharge. Participants received a “Managing Your Heart Failure With Video Education” booklet to aid accessing the videos. HF knowledge and self-care were measured before and after VE using the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index. A patient log and satisfaction with each video was collected. Seventy participants enrolled and 30 completed the questionnaires. All-cause 30-day readmission data were compared to a randomly selected historical group from the previous months and year. Results Participants’ mean age was 66 years, 70% (21) were female, 67% (20) were Caucasian, 63% (19) high school educated or less, 83% (25) had hypertension, 73% (22) were New York Heart Association Class III-IV, and 43% (13) had HF with reduced ejection fraction. Mean Charlson Comorbidity Index scores was 6.2 ± 2.3. HF knowledge and self-maintenance scores increased (mean 1.7, + 3.2, p =.008, mean 13.96 + 20.99, p =.001 respectively). Participants’ scores improved by at least 5% on 20 of the 30 questions on the HF knowledge test. Self-efficacy (self-care confidence) and self-care management did not significantly improve (mean 1.67, SD 26.69, p = .735; mean 9.4, SD 22.7, p =.073 respectively). All-cause 30-day hospital readmissions did not significantly decrease (9 to 7, p= .276). HF patients were satisfied with the VE information (96%) and all would recommend the videos (100%). The videos rated most helpful were: Heart Failure Medications: Diuretics (71.4%), Managing Heart Failure: Limiting Sodium (65%), and Taking Your Heart Failure Medications (61.9%). Conclusion VE was associated with improved HF knowledge and self-maintenance with high patient satisfaction. HF Knowledge scores may further be used to tailor patient education based on identified knowledge gaps. Future work is needed to investigate whether self-efficacy and self-management improves with continued follow-up.

Nurse-led education for heart failure patients in developing countries.

a total of 131 cardiac centre-based nurses and 30 chronic heart failure patients participated in the study in Kuwait. Patients were surveyed a second time 3 to 6 months later, while being followed at an advanced heart failure clinic by dedicated heart failure nurses. the majority of the nurses (80%) had not received heart failure education previously, although they were able to recognise most heart failure symptoms. Significant improvement in patients' knowledge was noted between the initial and follow-up surveys. establishing a dedicated advanced heart failure programme to care for patients in a developing country can result in significant improvement in disease awareness and self-care behaviours when led by well-trained heart failure nurses. More research is needed to determine if these findings are shared by other countries in the Middle-East and other developing countries.

Symptom Diary Use and Improved Survival for Patients With Heart Failure.

Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model. In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes. URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.

The Self-care Educational Intervention for Patients With Heart Failure: A Study Protocol.

A variety of educational interventions have been implemented to assist patients with heart failure (HF) to maintain their own health, develop self-care behaviors, and decrease readmissions. The most effective approach to education has yet to be established. The aim of this study is to determine the effectiveness of a multimedia educational intervention for patients with HF in reducing hospital readmissions. Secondary outcomes include changes in knowledge and self-care behaviors. A randomized controlled trial in a large tertiary referral hospital in Australia has recruited 200 patients and will follow them for 12 months. Patients diagnosed with HF have been randomly allocated 1:1 to either usual education or a multimedia educational intervention. Framed by the principles of adult learning, this individualized intervention was delivered face to face by a specialized HF nurse, with a targeted educational assessment and subsequent development of an educational plan. The multimedia approach combined viewing a DVD and verbal discussion supported by a written manual. The teach-back strategy at the conclusion of the intervention evaluated the patient's learning through 5 key questions about self-management of HF. Readmissions are assessed at 28 days, 3 months, and 12 months. Knowledge and self-care behavior are assessed at baseline, 3 months, and 12 months. This study evaluates the effectiveness of a targeted multimedia educational intervention. Study results may inform the design of in-hospital education for HF patients.