Association between a stepwise health education model based on evidence-based practice and self-care behaviors of patients with chronic heart failure: a single-center retrospective cohort study

Objective This study aims to investigate the association between a stepwise health education model based on evidence-based practice (EBP) and self-care behaviors, cardiac function improvement, and clinical outcomes in patients with chronic heart failure (CHF). Methods A retrospective analysis was performed on the clinical data of 120 patients with CHF admitted to our hospital from January 2023 to December 2024. The patients were divided into a control group (CG, n = 62, receiving routine health education) and an intervention group (IG, n = 58, receiving stepwise health education based on EBP in addition to routine care) according to the health education strategy received. The 6-month total score of the EHFScB-9 was defined as the primary outcome. Cardiac function indicators (LVEF, BNP, and 6MWD), biochemical indicators, clinical outcomes, individual scale items, and hospitalization-related indicators were considered exploratory outcomes. Factors associated with the occurrence of composite endpoint events were analyzed. Results After 6 months of intervention, the IG exhibited significantly higher LVEF and 6MWD and significantly lower BNP level than the CG ( P < 0.05). The serum sodium level in the IG was significantly higher than that in the CG ( P < 0.05). Exploratory analyses showed that the nominal P values for the 30-day, 90-day, and 6-month readmission rates, as well as the incidence of composite endpoint events, were all <0.05 in the IG. The average length of stay and total hospitalization costs in the IG were significantly lower than those in the CG ( P < 0.05); however, these findings were interpreted as exploratory. At the 6-month follow-up, the IG exhibited lower total EHFScB-9 scores and lower scores for individual items than the CG ( P < 0.05), indicating better self-care behaviors. Comparisons of individual items were exploratory findings. Multivariable analysis revealed that NYHA class III-IV (OR = 3.765), concomitant atrial fibrillation (OR = 2.440), LVEF < 40% (OR = 3.184), and lack of stepwise health education based on EBP (OR = 2.607) were associated with the composite endpoints. Conclusion In this single-center retrospective cohort study, analyses without adjustment for multiple comparisons suggested that a step health education model based on evidence-based practice was associated with better self-care behaviors, improved cardiac function, and lower rates of readmission and composite endpoint events.