Published on in Vol 9 (2023)

Preprints (earlier versions) of this paper are available at, first published .
Clinical Outcomes After Viewing Video Education on Danger Signs and Symptoms of Worsening Heart Failure and Self-care Actions

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

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


1Cleveland Clinic, Cleveland, OH, United States

2Atrium Health, Macon, GA, United States

3Wellspan Health, York Hospital, York, PA, United States

*these authors contributed equally

Corresponding Author:

Nancy Albert, PhD

Cleveland Clinic

9500 Euclid Avenue

Mail code J3-4

Cleveland, OH, 44195

United States

Phone: 1 2164447028

Fax:1 2164451776


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: NCT03657459;

Conflicts of Interest: None declared.

iproc 2023;9:e41064



Edited by B Dinesen; This is a non–peer-reviewed article. submitted 13.07.22; accepted 01.02.23; published 15.02.23


©Nancy Albert, Carol Babcock, Anna Maria Gray-Leyko, James Bena, Shannon Morrison, Dorothy Sayler, Michelle Levay. Originally published in Iproceedings (, 15.02.2023.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Iproceedings, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.