Nurse-Led Heart Failure Education and Patient Outcomes: A Mixed-Methods Prospective Registry Study

Background Patient understanding of heart failure (HF) self-care varies widely and is inconsistently associated with clinical outcomes. We examined knowledge acquisition and patient experiences related to structured HF education using a patient handbook. Methods and Results Between April and December 2021, 56 patients hospitalized for acute HF (mean age 74 years, 35% women, 46% HFrEF) were enrolled from 176 screened patients at a single center. A 20-item knowledge assessment was administered before and after nurse led HF education and at first outpatient follow-up. Thirty patients met criteria for knowledge improvement (≥5-point increase or baseline ≥15), while 25 did not. Knowledge gaps were most evident in exercise, medication effects, salt restriction, and recognition of exacerbating factors. Patients with knowledge improvement had higher post-education scores (16 vs. 12), sustained knowledge at follow-up, higher serum albumin levels, better inpatient dietary intake. One-year mortality and HF readmission did not differ. A nested qualitative analysis of four readmitted patients identified 94 codes grouped into 9 categories, highlighting personalized symptom recording, persistent self-management challenges despite handbook use, enhanced communication with healthcare professionals, reflection on future care, and a desire for earlier HF education. Conclusions Patients who achieved higher HF knowledge scores demonstrated better nutritional status but similar one-year clinical outcomes. Qualitative findings underscore ongoing challenges in long-term HF self-care.