Objective: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. Methods: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. Results: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001). Conclusion: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862 Visita domiciliar mejora conocimiento, auto cuidado, adhesión en la insuficiencia cardíaca: Ensayo Clínico Aleatorizado HELEN -IObjetivo: Verificar el efecto de una intervención educativa de enfermería combinada de visita domiciliaria y contacto telefónico en pacientes con internación reciente por insuficiencia cardiaca descompensada, en el conocimiento de la enfermedad, las habilidades para el autocuidado y la adhesión al tratamiento comparado con el acompañamiento convencional de pacientes en el período de seis meses. Métodos: Ensayo Clínico Aleatorizado en pacientes que fueron ingresados recientemente por insuficiencia cardiaca descompensada. El grupo intervención recibió cuatro visitas domiciliarias y cuatro contactos telefónicos para reforzar las orientaciones en seis meses de acompañamiento; el grupo control recibió acompañamiento convencional sin visitas y sin contactos telefónicos. Resultados: Fueron aleatorizados doscientos pacientes (101: intervención y 99: control). Tras seis meses, se observó una mejoría significativa en el conocimiento y el autocuidado para el grupo intervención (P=0,001 y P<0,001), respectivamente; la adhesión al tratamiento, comparada al final entre los grupos, fue significativamente mayor en el grupo intervención (P<0,001). Conclusión: La estrategia de visita domiciliaria para pacientes internados recientemente por insuficiencia cardiaca descompensada fue efectiva en la mejora de los desenlaces evaluados y su implementación merece ser considerada en Brasil con objeto de evitar internaciones no planificadas. NCT- 01213862Descriptores: Aprendizage; Autocuidado; Cooperación del Paciente; Enfermagem; Visita Domiciliaria.

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Background and objective: Nonadherence to sodium restriction is one of the main precipitating factors of heart failure (HF) decompensation. The three-subscale Dietary Sodium Restriction Questionnaire (DSRQ) enables evaluation of factors that can interfere with adherence. The objective of this study was to assess knowledge, barriers, and attitudes of patients with decompensated HF toward dietary sodium, by comparing those hospitalized for decompensation due to dietary nonadherence (alone or with medication nonadherence) versus those admitted for decompensation due to other causes. Methods: Cross-sectional study carried out at the emergency departments of two public hospitals in Southern Brazil between 2013 and 2014. The sample included patients admitted for decompensated HF. Patients were divided into two groups: decompensation due to nonadherence to diet (alone or with medication nonadherence) and other causes. Results: A total of 225 patients were included (mean age 66 ± 12 years). Patients exhibited a high degree of knowledge about sodium restriction (up to 50% achieved 40 of 45 points). The opinions of family and health professionals influenced adherence. The main barriers to adherence concerned palatability and dietary preferences. When compared to patients admitted for other causes, those decompensated due to nonadherence had lower ejection fraction (p = .004) and higher Perceived Behavioral Control subscale scores (p = .009). Conclusions: Patients have a high level of knowledge about sodium restriction. The opinion of significant others affects adherence. Nonadherent patients appeared to be more severely ill and endorsed a greater number of barriers that prevent adequate behavior. Some factors-particularly the taste of foods and patients' dietary preferences -may justify the high prevalence of nonadherence.

RESUMOO objetivo deste estudo metodológico foi realizar adaptação transcultural e validar para uso no Brasil um questionário de conhecimento dos fatores de risco cardiovascular (Q-FARCS), mudança do estilo de vida e adesão em uma amostra de ABSTRACTUsing a sample of patients with coronary artery disease, this methodological study aimed to conduct a cross-cultural adaptation and validation of a questionnaire on knowledge of cardiovascular risk factors (Q-FARCS), lifestyle changes, and treatment adherence for use in Brazil. The questionnaire has three scales: general knowledge of risk factors (RFs); specific knowledge of these RFs; and lifestyle changes achieved. Cross-cultural adaptation included translation, synthesis, back-translation, expert committee review, and pretesting. Face and content validity, reliability, and construct validity were measured. Cronbach's alpha for the total sample (n = 240) was 0.75. Assessment of psychometric properties revealed adequate face and content validity, and the construct revealed seven components. It was concluded that the Brazilian version of Q-FARCS had adequate reliability and validity for the assessment of knowledge of cardiovascular RFs. DESCRIPTORS Coronary disease Risk factors Health education Questionnaires Validation studies RESUMENEl objetivo de este estudio metodológico fue realizar la adaptación transcultural y validar para su uso en el Brasil, un cuestionario de conocimiento de los factores de riesgo cardiovascular (Q-FARCS), el cambio del estilo de vida y adhesión al tratamiento en una muestra de pacientes con enfermedad arterial coronaria. El cuestionario está dividido en tres scores: conocimiento general de los factores de riesgo; conocimiento específico y cambios en el estilo de vida. La adaptación transcultural incluyó traducción, síntesis, retro-traducción, aná-lisis por comité de especialistas y pre-test. Validez de apariencia y contenido, confiabilidad y validez de constructo fueron medidas. En la muestra total (n=240) el Alfa de Cronbach fue de 0,75. En el análisis de las propiedades psicométricas, la validez de apariencia y de contenido se mostraron adecuadas; la validez de constructo indicó siete componentes. Se concluye que la versión adaptada para el Brasil del Q-FARCS presentó adecuada confiabilidad y validez para evaluar el conocimiento de los factores de riesgo cardiovascular.

This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care.