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

Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = −0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties.

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