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Heart Failure; With DecompensationNCT03657459

Danger Signs in Heart Failure- Effects of Video Education

A study testing Danger Signs of Heart Failure Videos in people with Heart Failure; With Decompensation, run by The Cleveland Clinic at 8 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

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). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Heart Failure; With Decompensation
What is being tested?
Danger Signs of Heart Failure Videos
Could I receive a placebo?
No, everyone receives an active treatment
How many people
746 participants
Where
8 sitesUnited States
Study dates
26 Jul 2018to 31 May 2022
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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.

Who cannot join

  • 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).

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

United States8 sites
  • Cleveland Clinic Fairview Hospital

    Cleveland, Ohio, 44111

  • Cleveland Clinic main campus

    Cleveland, Ohio, 44195

  • Cleveland Clinic Marymount Hospital

    Garfield Heights, Ohio, 44125

  • Medical Center Navicent Health

    Macon, Georgia, 31201

  • Cleveland Clinic Hillcrest Hospital

    Mayfield Heights, Ohio, 44124

  • Cleveland Clinic Medina Hospital

    Medina, Ohio, 44256

  • Cleveland Clinic South Pointe Hospital

    Warrensville Heights, Ohio, 44122

  • WellSpan Health

    York, Pennsylvania, 15198

Other trials in United States

About this study

Official title: Danger Signs of Worsening Heart Failure and Self-Management of Danger Signs: The Effects of Video Education

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. Investigators will determine if video education in HF danger signs recognition and control prior to discharge (and post-discharge) reduces all-cause and HF-related HCRU.

Read the detailed description

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.

Being tested
Danger Signs of Heart Failure Videos
Keywords
video education, self care management, symptom recognition
Medical subject headings
Heart Failure

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Danger Signs of Heart Failure VideosBehavioural

    Short (under 3 minutes each) videos on (a) recognition of dyspnea, fatigue and edema and (b) self-management of each (based on diet, fluid management and activities) that reflect patient behaviors

Study groups in NCT03657459
Study groupRoleWhat they receive
usual care groupNo interventionUsual care consists of patient's receiving a Heart Failure Handbook before hospital discharge + verbal education delivered by multiple care providers (including a group education class at 1 site). The handbook is consistent; however, verbal education may vary between care providers based on their knowledge and time available, and perceived patient needs
video education groupActive comparatorWill receive usual care, plus will watch 2 short Wellflix, Inc. Danger Signs of Heart Failure videos (via iPAD) on dyspnea, fatigue + a Danger Sign "edema" video, when applicable. Each video describes how to recognize if the sign/symptom is new or worsening and how to self-manage at home (via diet, fluid management and activity instructions)
Receives: Behavioral: Danger Signs of Heart Failure Videos

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With HF-related Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with HF-related healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 30 days of discharge.

    Measured: up to 30 days

Secondary outcomes (29)
  1. Number of Participants With HF-related Hospitalization

    Total number of participants post-discharge with HF-related hospitalization

    Measured: up to 30 days

  2. Number of Participants With HF-related ED Visits

    Number of participants with post-discharge HF-related ED visits

    Measured: up to 30 days

  3. Number of Participants With HF-related Death

    Number of participants post-discharge with HF-related death

    Measured: up to 30 days

  4. Number of Participants With HF-related Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with HF-related healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 90 days of discharge.

    Measured: up to 90 days

  5. Number of Participants With HF-related Hospitalization

    Number of participants post-discharge with HF-related hospitalization

    Measured: up to 90 days

  6. Number of Participants With HF-related ED Visit

    Number of participants post-discharge with HF-related ED visit

    Measured: up to 90 days

  7. Number of Participants With HF-related Death

    Number of participants post-discharge with HF-related death

    Measured: up to 90 days

  8. Number of Participants With HF-related Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with HF-related healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 180 days of discharge.

    Measured: up to 180 days

  9. Number of Participants With HF-related Hospitalization

    Number of participants post-discharge with HF-related hospitalization

    Measured: up to 180 days

  10. Number of Participants With HF-related ED Visit

    Number of participants post-discharge with HF-related ED visit

    Measured: up to 180 days

  11. Number of Participants With HF-related Death

    Number of participants post-discharge with HF-related death

    Measured: up to 180 days

  12. Number of Participants With All-cause Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with all-cause healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 30 days of discharge.

    Measured: up to 30 days

  13. Number of Participants With All-cause Hospitalization

    Number of participants post-discharge with all-cause hospitalization

    Measured: up to 30 days

  14. Number of Participants With All-cause ED Visits

    Number of participants with post-discharge all-cause ED visits

    Measured: 30 days

  15. Number of Participants With All-cause Death

    Number of participants post-discharge with all-cause deaths

    Measured: up to 30 days

  16. Number of Participants With All-cause Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with all-cause healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 90 days of discharge.

    Measured: up to 90 days

  17. Number of Participants With All-cause Hospitalization

    Number of participants with post-discharge all-cause hospitalization

    Measured: up to 90 days

  18. Number of Participants With All-cause ED Visits

    Number of participants post-discharge with all-cause ED visits

    Measured: up to 90 days

  19. Number of Participants With All-cause Death

    Number of participants post-discharge with all-cause death

    Measured: up to 90 days

  20. Number of Participants With All-cause Healthcare Resource Utilization (HCRU)

    Number of participants post-discharge with all-cause healthcare resource utilization including hospitalization, emergency department (ED) visits, death, or cardiac transplant within 180 days of discharge.

    Measured: up to 180 days

  21. Number of Participants With All-cause Hospitalization

    Number of participants post-discharge with all-cause hospitalization

    Measured: up to 180 days

  22. All-cause ED Visits at 180 Days

    Number of participants post-discharge with all-cause ED visits

    Measured: up to 180 days

  23. All-cause Death at 180 Days Post Discharge

    Number of participants post-discharge with all-cause death

    Measured: up to 180 days

  24. Functional Status Using the Duke Acrivity Status Index Scale at 30 Days Post Discharge

    Duke Activity Status Index (DASI) score at 30 days. Patients completed the DASI, a 12-item questionnaire using a Likert-like scale that determines a patient's ability to participate in daily self-care activities including ambulation, housework, yard work, sexual relations, and recreational activities. A total score reflects functional status based on responses. The full range of scores is 0 (most severe functional impairment) to 58.2 (no functional impairment). There is no established cut-point for this scale. Positive, higher scores reflect a positive and better functional status.

    Measured: up to 30 days

  25. Dyspnea at 30 Days Post Discharge

    PROMIS® Dyspnea Functional Limitations - Short Form 10a was used. It is a 10-item tool that measures dyspnea by asking 10 questions about the difficulty in completing activities in the past 7 days. Responses range from "0 = no difficulty" to "3 = much difficulty" and there is an option for "I did not do this in the past 7 days" - there were 5 response options in total. Minimum and maximum raw scores are 0-30. PROMIS T scores are standardized with scores around 50 (standard deviation of 10) equating to normal/average levels and scores above or below equating to heightening or lessening of the variable being measured. A 5 point change in score is considered significant. A table is used to translate the total raw score to T score for each participant.

    Measured: 30 days

  26. Fatigue at 30 Days Post Discharge

    10-item Fatigue Assessment Scale from baseline. The Fatigue Assessment Scale is a valid, reliable 10-item scale evaluating symptoms of chronic fatigue. It uses Likert-type response options ranging from 1 ("never") to 5 ("always"), with some items reverse scored. Total scores range from 10 (lowest level of fatigue) to 50 (highest level of fatigue).

    Measured: to 30 days

  27. Self-efficacy for Managing Symptoms at 30 Days Post Discharge

    PROMIS Self-Efficacy for Managing Symptoms Short form 8a for managing symptoms, from baseline. 8-item tool that ranges from 'I am not at all confident' to 'I am very confident" - higher scores equals higher self-efficacy. A mean score of 50 is the average score in the general population of U.S. with standard deviation of 10. A table is used to translate the total raw score to T score for each participant. The T score rescales the raw score into a standardized score with a mean of 50 and a standard deviation of 10. Higher scores (above 50) reflect better than average self-efficacy

    Measured: 30 days

  28. Intervention Group Only- All-cause Events Based on Dichotomous Metric of Viewing the Video at Home (Never vs 1+)

    Among intervention group participants, total number of all-cause events within 30 days of discharge, based on the number of times the patient watched the video education. Participant responses are grouped into two categories: Never watched vs. 1 or more times

    Measured: 30 days

  29. Intervention Group Only; Number of All-cause Events Based on Dichotomous Outcome of Family Member Viewing Educational Video After Hospital Discharge (Yes vs no)

    Total number of participants (video education group only), comparison of all-cause events within 30 days of discharge, based on family members watching the educational videos after the hospital (Yes/No).

    Measured: 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Sep 2018
  2. Study start26 Jul 2018
  3. Primary completion20 Oct 2021
  4. Study completion31 May 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized, controlled prospective trial
Masking
Double blind
Who is masked
Care provider, Investigator
Enrolment
746 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03657459
Sponsor's protocol ID
18-442
Status last verified
Apr 2025
First submitted
30 Aug 2018
Last updated
7 May 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No plans to share individual data

Questions about this trial

What is this clinical trial studying?

A study testing Danger Signs of Heart Failure Videos in people with Heart Failure; With Decompensation, run by The Cleveland Clinic at 8 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 May 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With HF-related Healthcare Resource Utilization (HCRU) (time frame: up to 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 May 2025.

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