Heart Failure, Heart Failure Hospitalization, Readmission, Hospital
Conditions
Keywords
heart failure, hospital readmission, patient education, teach-back method, self-care, health literacy, discharge planning, transitional care, evidence-based practice, nursing intervention, quality improvement, systolic heart failure, medication adherence, symptom monitoring, lifestyle modification
Brief summary
This study aimed to improve how patients with heart failure understand and manage their condition after leaving the hospital. Many heart failure patients are readmitted within 30 days due to confusion about their discharge instructions and difficulty following self-care routines. The study tested whether a structured discharge education session using the "teach-back" method-where patients repeated instructions in their own words-could help improve their knowledge and self-care behaviors. The goal was to reduce hospital readmissions and help patients feel more confident managing their heart failure at home.
Detailed description
Heart failure is a chronic and progressive condition affecting millions of adults in the United States. Despite advances in treatment, nearly one in four patients are readmitted to the hospital within 30 days of discharge, often due to poor understanding of discharge instructions and inadequate self-care. These readmissions contribute to worse health outcomes and increased healthcare costs. This study evaluated the effectiveness of a structured discharge education intervention using the teach-back method. The teach-back method is a communication technique in which patients are asked to repeat discharge instructions in their own words. This approach helps confirm understanding, reinforce learning, and promote active engagement in self-care. The study used a quasi-experimental, pre-test/post-test design to assess changes in patients' knowledge and self-care behaviors before and after the intervention. Participants were adults hospitalized with systolic heart failure (LVEF ≤ 40%) who meet specific clinical criteria. Each participant received a 30-minute individualized education session at discharge, covering key self-care topics such as medication adherence, symptom monitoring, fluid restriction, and dietary modifications. Printed educational materials from the American Heart Association were also provided. To measure outcomes, participants completed the European Heart Failure Self-care Behavior Scale (EHFScB-9) before and after the intervention. Thirty-day readmission data was collected through a retrospective review of hospital records. The study aimed to determine whether teach-back education improved self-care behaviors and reduced 30-day readmission rates. This project was reviewed and exempted by the Nova Southeastern University Institutional Review Board under Exempt Category 2. It aligned with national goals to improve patient education, reduce preventable readmissions, and enhance the quality of care for individuals with heart failure.
Interventions
A structured, 30-minute discharge education session delivered in person using the teach-back method. Participants are asked to restate instructions in their own words to confirm understanding. The session covers key heart failure self-care behaviors including medication adherence, symptom monitoring, fluid restriction, and dietary modifications. Printed educational materials from the American Heart Association are also provided.
Sponsors
Study design
Intervention model description
All participants received the same intervention: structured discharge education using the teach-back method. There was no control group or comparison between multiple interventions. The study used a pre-test/post-test design within a single group to evaluate changes in self-care behaviors and readmission rates.
Eligibility
Inclusion criteria
* Adults aged 18 years and older * Diagnosed with systolic heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% * Classified as New York Heart Association (NYHA) Class II, III, or IV * Categorized as American College of Cardiology/American Heart Association (ACC/AHA) Stage C or D * Currently hospitalized at the project site * Able to read and understand English at an 8th grade reading level * Have access to a smartphone or tablet capable of scanning QR codes and connecting to the internet * Provide voluntary informed consent via the REDCap platform
Exclusion criteria
* Cognitive impairment * Non-English speaking * Unwilling to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Heart Failure Self-Care Behaviors (EHFScB-9 Total Score) | Baseline (pre-intervention) and immediately post-intervention on the same day, up to 35 minutes after the start of the education session. | The 9-item European Heart Failure Self-Care Behavior Scale (EHFScB-9) was used to assess self-care behaviors. Each item is scored on a 5-point Likert scale ranging from 1 ("completely agree") to 5 ("do not agree at all"), producing a total score range of 9 to 45. The outcome represents the change in total EHFScB-9 score from baseline (pre-intervention) to immediately post-intervention following the discharge education session. Lower total scores indicate better self-care performance (more consistent adherence to recommended behaviors), while higher total scores indicate poorer self-care performance (less consistent adherence). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With 30-Day Heart Failure Readmission | Assessed during the 30-day period following hospital discharge. | Readmission status was determined from hospital records and participants were classified as readmitted (Yes) or not readmitted (No) within 30 days of discharge. Data are displayed as counts in the results table. |
Countries
United States
Contacts
Nova Southeastern University, Ron and Kathy Assaf College of Nursing
Participant flow
Recruitment details
Recruitment occurred over a 30-day period (Sep 11-Oct 11, 2025) on inpatient medical/cardiac units at a single hospital. Potential participants were identified during routine care by an advanced heart failure cardiologist and referred to the primary investigator, who screened eligibility at discharge and obtained electronic consent via REDCap using a QR code in the patient's room.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Customized 18 years and older | 57 Participants |
| Pre-intervention EHFScB-9 Total Score | 27.96 EHFScB-9 scores on a scale (9-45) STANDARD_DEVIATION 7.81 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 57 |
| other Total, other adverse events | 0 / 57 |
| serious Total, serious adverse events | 0 / 57 |