Danger Signs in Heart Failure- Effects of Video Education

The most frequently cited danger signs of heart failure (HF) are new onset or worsening of
fatigue, dyspnea and edema. In previous research, patients did not recognize worsening HF,
due to 3 primary reasons: (1) danger signs were non-specific and misinterpreted as stress, an
external force or another comorbidity, (2) danger signs were unrecognized due to the subtle
nature of worsening status, or (3) when patients eliminated or minimized activities that
prompted danger signs, they interpreted the results as improvement in status. Lack of
recognition of HF danger signs and lack of understanding of how to control and minimize
danger signs could lead to their escalation and prompt all-cause and HF-related health care
resource utilization (HCRU). Investigators hypothesize that patients must understand HF
danger signs to have self-confidence in recognizing them and in taking steps to minimize or
eliminate their occurrence post hospital discharge. The purposes of this trial are to
determine if video education in HF danger signs recognition and control prior to discharge
(and post-discharge) reduces all-cause and HF-related health care resource utilization. The
intervention will be administered during hospitalization, and patients and family members
will receive a link to a website and a DVD to review videos as often as desired
post-discharge. The primary end-point is 30-day HF-related hospitalization. 732 patients (658
+ 10% attrition) with decompensated HF will be enrolled from multiple hospitals.

Inclusion Criteria:

- Not referred for cardiac transplantation or ventricular assist device placement during
the index hospitalization,

- Cognitively intact and able to view videos (adequate eyesight and hearing) with
correction, if needed,

- Discharge to home, assisted living facility or to a family member's home and can
control dietary sodium and fluids as needed,

- Willing to participate; which may require up to three (3) follow-up telephone calls
post-discharge.

Exclusion Criteria:

- Chart documented psychiatric or cognitive conditions that limit ability to understand
video content or adhere to self-care recommendations (Alzheimer's condition, dementia,
schizophrenia, other neurological history that impairs memory or concentration),

- Plans to discharge to skilled nursing facility or hospice care,

- Receiving home hospice or palliative care; or has a medical condition reflecting less
than 1 year of survival (cachexia, end stage liver disease or cancer or non-ambulatory
New York Heart Association functional class IV HF),

- Hospitalized but at admission, in New York Heart Association functional class I or II
HF

- Post-cardiac transplantation or ventricular assist device placement,

- Currently enrolled in another experimental HF research study,

- Chronic renal failure and receiving chronic hemodialysis therapy for an estimated
glomerular filtration rate < 15 mL/minute/1.73 m2,

- A non-traditional form of HF (hypertrophic or restrictive forms of cardiomyopathy,
congenital heart disease or Takotsubo cardiomyopathy).