@Article{info:doi/10.2196/41064,
author="Albert, Nancy
and Babcock, Carol
and Gray-Leyko, Anna Maria
and Bena, James
and Morrison, Shannon
and Sayler, Dorothy
and Levay, Michelle",
title="Clinical Outcomes After Viewing Video Education on Danger Signs and Symptoms of Worsening Heart Failure and Self-care Actions",
journal="iproc",
year="2023",
month="Feb",
day="15",
volume="9",
pages="e41064",
keywords="heart failure; video education; danger signs",
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. ",
issn="2369-6893",
doi="10.2196/41064",
url="https://www.iproc.org/2023/1/e41064",
url="https://doi.org/10.2196/41064"
}