Aims Home‐based interventions for heart failure (HF) patients might be particularly effective in middle‐income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment. Methods and results HELEN‐II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse‐based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN‐II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow‐up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤24 h), a hospital readmission (>24 h), or all‐cause death, assessed during the first 6 months of follow‐up. Most enrolled subjects were middle‐aged (62 ± 13 years) males (63%) in NYHA functional class II–III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54–0.99; P = 0.049). At the end of follow‐up, the rate of use of the standard‐of‐care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self‐care were significantly increased in the interventional group. Conclusions A post‐discharge, nurse‐led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle‐income country. Trial registration NCT01213875

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Objective: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. Methods: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. Results: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001). Conclusion: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862 Visita domiciliar mejora conocimiento, auto cuidado, adhesión en la insuficiencia cardíaca: Ensayo Clínico Aleatorizado HELEN -IObjetivo: Verificar el efecto de una intervención educativa de enfermería combinada de visita domiciliaria y contacto telefónico en pacientes con internación reciente por insuficiencia cardiaca descompensada, en el conocimiento de la enfermedad, las habilidades para el autocuidado y la adhesión al tratamiento comparado con el acompañamiento convencional de pacientes en el período de seis meses. Métodos: Ensayo Clínico Aleatorizado en pacientes que fueron ingresados recientemente por insuficiencia cardiaca descompensada. El grupo intervención recibió cuatro visitas domiciliarias y cuatro contactos telefónicos para reforzar las orientaciones en seis meses de acompañamiento; el grupo control recibió acompañamiento convencional sin visitas y sin contactos telefónicos. Resultados: Fueron aleatorizados doscientos pacientes (101: intervención y 99: control). Tras seis meses, se observó una mejoría significativa en el conocimiento y el autocuidado para el grupo intervención (P=0,001 y P<0,001), respectivamente; la adhesión al tratamiento, comparada al final entre los grupos, fue significativamente mayor en el grupo intervención (P<0,001). Conclusión: La estrategia de visita domiciliaria para pacientes internados recientemente por insuficiencia cardiaca descompensada fue efectiva en la mejora de los desenlaces evaluados y su implementación merece ser considerada en Brasil con objeto de evitar internaciones no planificadas. NCT- 01213862Descriptores: Aprendizage; Autocuidado; Cooperación del Paciente; Enfermagem; Visita Domiciliaria.

Objective: To assess treatment adherence in patients with heart failure receiving nurse-led home visits after hospital discharge. Methods: This was a before-and-after study involving patients who had been recently hospitalized for decompensated heart failure. Three home visits were conducted within 45 days of hospital discharge. Treatment adherence was assessed in the first and third visits through a 10-item questionnaire (cutoff point: 18 = 70% adherence). In the first and second visits, patients were educated as to their condition, treatment adherence and self-care. Results: There were 32 patients included, mean age 65±16 years, 18(58%) male. The 32 patients received a total of 96 home visits. Treatment adherence scores were of 16±2.6 vs 20.4±2.7 in the first and third visits, respectively (p=0,001). Weight monitoring and liquid restriction behaviors improved significantly following the intervention. Conclusion: The in-home educational intervention led to significant improvements in the treatment adherence of recently-hospitalized patients with heart failure. ResumoObjetivo: Verificar a adesão ao tratamento de pacientes com insuficiência cardíaca em acompanhamento domiciliar por enfermeiras após alta hospitalar. Método: Estudo tipo antes-depois realizado com pacientes recentemente internados por insuficiência cardíaca descompensada. Três visitas domiciliares foram realizadas após alta em um intervalo de 45 dias. Avaliou-se a adesão na primeira e terceira visitas através de um questionário validado (10 questões, ponto de corte 18 pontos=70%=adesão satisfatória). Durante a primeira e segunda visitas, os pacientes receberam educação quanto à doença, adesão e autocuidado. Resultados: Foram incluídos 32 pacientes, idade média 65±16 anos, 18(58%) masculinos. Os 32 pacientes receberam um total de 96 visitas domiciliares. Os escores de adesão foram 16±2.6 vs 20.4±2.7 na primeira e terceira visitas, respectivamente (p=0,001). Questões como peso e restrição hídrica aumentaram significativamente após a intervenção. Conclusão: A intervenção de educação no domicílio melhorou significativamente a adesão ao tratamento de pacientes com insuficiência cardíaca e internação recente.

Aim:To assess the knowledge about the disease and their self-care of patients with heart failure (IC) before and after monitoring nursing care at home. Method: A before and after experimental study was performed with patients who were hospitalized for IC decompensation. Two home visits (VD) were undertaken after hospital discharge by specialist nurses at an interval of 30 days. 14 question quiz testing knowledge of heart disease and self-care, validated for use in Brazil, was used. The educational intervention was based on guidelines about IC. It was considered that an appropriate level of knowledge existed in those patients who had at least 70% correct on the quiz. Results: 41 patients were included, 21 (51.2%) of whom were men. The whole group had an average age of 64 ± 13.7 years. The correct answer scores were 64% in VD1 and 70.9% in VD2 (P = 0.020). Discussion: Nursing interventions benefit patients by improving their knowledge. Conclusion: There was a significant improvement in terms of knowledge of heart disease and self-care after the homecare interventions.