Possible Novel Heart Failure Education Method Shows Promise

A 5-phase program designed to increase knowledge among patients with heart failure has shown promise in more effective disease management and hospital readmission reduction.

A 5-phase program designed to increase knowledge among patients with heart failure about their condition has shown promise in helping these individuals more effectively manage their disease and reduce potential hospital readmissions, reports a study in European Journal of Cardiovascular Nursing.

“Despite published guidelines emphasizing the importance of education in the management of heart failure, the most effective method of education remains unknown,” wrote the authors. “The aim of this study was to test the efficacy of [a] constructivist teaching method on the patients with heart failure.”

Their single-center, randomized, controlled trial compared outcomes between 2 patient cohorts, each containing 61 individuals (N = 122), from one of the largest general hospitals in Greece. Most (83.6%) were men, and the mean (SD) age was 67.1 (12.3) years. The intervention group received the full constructivist teaching method, which comprised 5 phases:

  1. Orientation
  2. Elicitation
  1. Restructuring
  2. Application
  3. Review

Meanwhile, those in the control group received standard care. The primary outcomes were quality of life, medication adherence, and functional status at 3 and 6 months. At the end of the 6-month period, 5 questionnaires were used to evaluate outcomes:

  • Atlanta Heart Failure Knowledge Test
  • Minnesota Living with Heart Failure
  • Self-Efficacy for Appropriate Medication Use Scale
  • European Heart Failure Self-care Behaviour Scale
  • Duke Activity Status Index

Overall results show that at the 1-month and 6-month follow-up marks, respectively, 67% and 64% fewer patients in the intervention group had been rehospitalized vs the control group:

  • 1 month: 8.2% vs 24.6% (P = .014)
  • 6 months: 13.1% vs 36.1% (P = .003)

In addition, at the 6-month mark, more intervention patients had no hospitalization days compared with the control group: 93.4% vs 75.4% (P = .003).

Also, for quality of life, a larger mean improvement was seen in the intervention group than in the control group: –29.21 vs –15.44. However, improvements were seen in both groups when comparing baseline to 3 months and 3 to 6 months.

Similar results were seen regarding the knowledge test, adherence to therapy, treatment/recommendation adherence, fluid and sodium management, physical activity, and recognition of deteriorating symptoms (all P < .001). Despite both groups seeing overall improvements, there was a greater degree of improvement for the intervention vs control group in all measures.

This takes on even more significance considering that more patients in the control group were overweight or obese compared with the intervention group: 37.7% and 42.6% vs 32.8% and 31.1%, respectively.

“Heart failure education can enhance medication adherence and should be offered to patients with recent hospitalization,” the authors emphasized. “Patients with high knowledge of heart failure have improved their quality of life.”

Of note, the patients evaluated had 3 types of heart failure, which were equal in both cohorts: 62.3% had heart failure with reduced ejection fraction; 19.7%, mid-range ejection fraction; and 18.0%, preserved ejection fraction. However, slightly more patients in the control vs intervention group had New York Heart Association class III to IV disease: 45.9% vs 44.3% (P = .856).


Elpida K, Constantinos PH, Ioannis V, et al. A constructivist approach to teaching patients with heart failure: results from an intervention study. EurCardiovasc Nurs. Published online November 20, 2020. doi:10.1093/eurjcn/zvaa003