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:
To examine if video education of HF danger signs/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 and all-cause and HF-related hospitalization, emergency department (ED) 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. 30-day functional status, fatigue, dyspnea and self-efficacy for managing symptoms were assessed using valid, reliable tools. In analysis, multivariable models were created to compare changes in patient-reported outcomes from baseline to 30-days post-discharge and morbidity/mortality outcomes up to 180 days.
Results:
Of 369 VE and 377 UC patients enrolled from 7 sites, mean (SD) age was 68.0 (12.4) years and 55.9% were male. At 30-days, there were no between-group differences in 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=.028 and 1.44 (1.05, 1.97), p=.025, respectively. In time-to-event adjusted analyses, video patients had earlier HF-related hospitalization, compared to UC patients; HR (95% CI) 1.32 (1.02, 1.72), p=0.039.
Conclusions:
Video education on recognition and control of danger signs/symptoms paradoxically increased HF-related events and hospitalization, and decreased time to first HF-related hospitalization. Increased recognition of subtle HF signs/symptoms via video education is valuable but must be connected to patient/family self-care actions that reduce HF signs/symptoms. Clinical Trial: NCT03657459
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