Background The ubiquity of the Internet is changing the way people obtain their health information. While there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. Objective The purpose of this study was to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Methods Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure websites. Two independent raters then assessed the quality and health literacy demand of the included websites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using seven established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials (PEMAT-P). Results A total of 46 websites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2. Finally, the overall mean actionability score was 34.7% ± 28.7. Conclusions The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality, but also the health literacy demand of the information found in their websites. This is especially important considering that low health literacy is likely prevalent among the usual audience.

Background Heart failure (HF) is a major healthcare burden and there is a growing need to develop strategies to maintain health and sustain quality of life in persons with HF. The purpose of this review is to critically appraise the components of nutrition interventions and to establish an evidence base for future advances in HF nutrition research and practice. Methods and results CINAHL, PUBMED, and EMBASE were searched to identify articles published between 2005–2015. A total of 17 randomized controlled trials were included in this review. Results were divided into two categories of nutrition-related interventions: (1) educational and (2) prescriptive Educational interventions improved patient outcomes such as adherence to dietary restriction in urine sodium levels and self-reported diet recall. Educational and prescriptive interventions resulted in decreased readmission rates and patient deterioration. Adherence measurement was subjective in many studies. Evidence showed that a normal sodium diet and 1 liter fluid restriction, along with high diuretic dosing enhanced BNP, aldosterone, TNF-a, and IL-6 markers. Conclusions Educational nutrition interventions positively impact patient clinical outcomes. While clinical practice guidelines support a low sodium diet and fluid restriction, research findings have revealed that a low sodium diet may be harmful. Future research should examine the role of macronutrients, food quality and energy balance in HF nutrition.

Conclusions: HF patients recognized various symptoms but many patients could not judge the symptom cause to be deterioration due to HF. Care-seeking delay was affected by the type of symptom, adequate judgment of the symptom cause, and support from family or cardiac health care professionals. To improve care-seeking behavior, patient education is needed to reinforce adequate recognition and evaluation of worsening symptoms.