Heart failure represents a major public health challenge in Saudi Arabia

Heart failure represents a major public health challenge in Saudi Arabia. Heart failure is characterized by an increase in prevalence, high costs, and a significant impact on quality of life and mortality (AlAyoubi, 2023). Having the right techniques to acquire data is essential to determine heart failure self-care behaviours, clinical results, and potential factors among the Saudi community. Self-reported scales such as the European Heart Failure Self-Care Behavior Scale (EHFScB) will be used to assess self-care maintenance, management, and confidence of heart failure patients. Such self-report scales directly assess the patients’ experiences with their daily management activities, symptom recognition, and self-efficacy beliefs (Jaarsma et al., 2021).  The medical record reviews will objectively supply clinical data on the disease characteristics, co-morbidities, treatments received, and healthcare utilization indicators, such as hospitalization rates. Therefore, this study will follow a quasi-experiment design showing how self-care practices affect HF outcomes.

Demographic Variables

The conceptualization of demographic variables is critical for this research. It provides a common understanding and a consistent approach to interpreting the variables across various contexts and populations relevant to the issue being studied. Conceptual definitions give a theoretical grounding for the variables, which ensures that they are valid representations of the intended constructs being studied (Gray et al., 2016). This strategy, on the other hand, improves the reliability and validity of the research outcomes. In the context of this research, the relevant demographic variables and their conceptual definitions are as follows:

1. Gender: This variable is categorical and defined as the socially constructed identity, roles, behaviours as consistent with other similar studies (Alshammri et al., 2023). The gender in this study is indicated via self-reporting and coded as male or female. From the aspect of self-care behaviours, treatment adherence, and seeking healthcare, gender differences will be observed among heart failure patients in Saudi Arabia.
2. Age: This is a continuous variable that refers to the number of elapsed years since birth. It will depend on the final duration of the elapsed years, as other scholars have already suggested (Chaudhary et al., 2024; Tromp et al., 2021). In this measure, age will be measured by self-reports and then divided into groups based on heart failure and self-care management of the sample distribution. The age groups will be divided into young adults (18-39 years), middle-aged (40-64 years), and older adults (65 years and above). This is the factor that is relevant in the research, and it determines health literacy, self-care ability, and readmission risks of heart failure patients (Wondmieneh et al., 2023).
3. Marital Status: This variable is a categorical one that denotes the current legally or socially accepted partnership of the participants. In this study, marital status will be measured by asking questions about it and grouped into married, single, divorced, and widowed. Marital status can make a difference in social support that also affects self-care management and outcomes of heart failure patients (Soofi et al., 2020). In this case, married couples might have a better chance of practising self-care routines. This, in turn, would make it less likely for them to be readmitted to the hospital.
4. Educational Level: This is an ordinal variable that reflects the highest formal education degree an individual has obtained. The study measures the level of education using self-report and classifies it as no formal education, primary education, secondary education, or tertiary education (undergraduate or postgraduate) (Soofi et al., 2020). People with poor health literacy may be low educated, which, in effect, can limit the capacity of patients with heart failure to take care of themselves. It may also affect their compliance with prescribed treatment protocols, and so, consequently, may lead to readmission.
5. Employment Status: This variable is nominal, specifying the current job activity of an individual. Work status will be ascertained through self-reporting and classified into employed, unemployed, and retired. Employment status can determine whether the patient will have enough healthcare resources and financial stability and whether the patient will participate in self-care activities (Aljohani, 2023). This will, thus, increase the rate of readmission of heart failure patients in Saudi Arabia.
6. Income Level/Socioeconomic Status: This is a multi-dimensional variable that incorporates one class in a society, which is defined by income, education, and occupation. This study will use the reported income levels and the validated socioeconomic status index of Saudi Arabia to determine the socioeconomic status. Socioeconomic status will be divided into categories according to how the sample will be segmented (for example, low, medium, and high). Monitoring this variable is essential for this research, as lack of health resources, financial strain, and barriers to self-care linked to low socioeconomic status can contribute to the heightened risk of readmission among heart failure patients.

Major Study Variables

It should be noted that for more reliable measurement and interpretation of results, it is important to define variables precisely. This section will define concepts, outline measurement tools, and present data related to the reliability and validity of the variables linked to heart failure readmissions and self-education programs.

30-Day Readmission Rate:

The 30-day readmission rate, which is a common outcome measure in heart failure studies, refers to the proportion of patients who are rehospitalized for heart failure within 30 days of discharge (Macchio et al., 2020). This is the principal outcome that this study plans to evaluate. It represents the number or percentage of hospital readmissions of heart failure patients after being discharged. This measure is regarded as a key indicator in the quality of care and is commonly used to assess the success of the programs targeting heart failure management improvement (Macchio et al., 2020; Madanat et al., n.d.; Rizzuto et al., 2022). One study detailed and operationalized this variable by tracking admissions and readmission rates of the patients within the 30-day window after heart failure hospitalization. They demonstrated that this variable is a valid and reliable outcome in heart failure research (Macchio et al., 2020). Readmissions can be linked to multiple other important clinical outcomes, such as death rates, and are often responsive to changes in the care processes. However, there will also be some limitations because even readmission rates are affected by factors outside the quality of care. These factors could be the demographics and co-morbidities of the patients, which may, consequently, cause negative health outcomes. The 30-day readmission rate is a binary variable (readmitted within 30 days or not). Therefore, traditional measures of internal consistency reliability, like Cronbach’s alpha, are not valid for this variable. Nonetheless, the replicability of this measure has been shown through its constant associations with other key outcomes, namely mortality and healthcare costs, across varied studies (Albinali et al., 2023; Aljabri, 2021; Alshammri et al., 2023; Macchio et al., 2020). This is a valid measure that shows the quality of care and healthcare system performance. It has been demonstrated that the measure is able to detect trends in healthcare delivery and stratagems directed towards better management of heart failures (Macchio et al., 2020). Furthermore, the 30-day readmission rate exhibits convergent validity because of its correlation with other indicators of poor performance, such as longer hospital stays and higher healthcare use. In this case, a higher score (that is, a higher percentage of patients readmitted within 30 days) is typically interpreted as an undesirable outcome, which may indicate some problems with the quality of care or patient transfers (Albinali et al., 2023; Aljohani, 2023).

Self-Care Education Programs:

Self-care programs for heart failure patients normally include lessons on medication management, symptom monitoring, and lifestyle modifications. This is the independent variable in this study. It is an educational initiative intended to educate patients about self-care, which involves details such as medication adherence, self-monitoring of the symptoms, and lifestyle changes (Aljohani, 2023). These programs try to change patients’ self-care attitudes. They primarily argue for patients to be actively involved in the management of their disease (Skouri et al., 2024). The key parts of such programs usually involve personalized learning, therapy, and care received from healthcare professionals. Scientific studies have outlined that educational programs aimed at self-care can increase self-care and reduce hospitalizations among heart failure patients (Aljohani, 2023; Alshammri et al., 2023; Mulugeta et al., 2022). Participants in these programs show better adherence to self-care instructions and have lower rates of readmission than those who receive no such intervention. These programs are subject to evaluation according to their effect on self-care behaviors and clinical outcomes, such as readmission rates. Demographic factors, as well as health-related elements like co-morbidities, are important variables that play a role in self-care behaviors and the likelihood of readmission in heart failure patients (Soofi et al., 2020; Tromp et al., 2021). These covariates should be accounted for when looking at the association between self-care, readmissions, and other outcomes. Researchers extract this information using standard demographic and medical history questionnaires (Aljohani, 2023). By transparently defining and operationalizing the key constructs, this research can guarantee that the measurements are reliable and valid. This is a precondition for drawing dependable conclusions from the studies and advising on clinical practice and policymaking on the management of cardiac failure.

Data Collection

The European Heart Failure Self-Care Behavior Scale (EHFScB-9)

EHFScB-9 is an accurate tool for evaluating patients with heart failure adherence to self-care behaviors. It deals with such behaviors as medication compliance, symptom monitoring, and lifestyle changes. The scale consists of 9 items, all on a 5-point Likert scale, and higher scores show better self-care conduct. Regarding the scores, 9-20 is low self-care, 21-32 is moderate, and 33-45 is high self-care. This affirms the relationship between higher scores on quality and better clinical results, such as reduced readmissions and lower scores on quality, which are connected with the need for intervention in patient self-management. The EHFScB-9 showed very good reliability, as Cronbach’s alpha of 0.61 was in a similar study (Mulugeta et al., 2022). Concerning validity, the EHFScB-9 showed evidence of construct validity, with positive correlations between self-care behaviors and health-related quality of life and medication adherence. In addition to that, the self-care behaviors as measured by the EHFScB-9 play a role in the prediction of important clinical outcomes, for instance, readmissions to hospital, which further demonstrates the predictive validity of the questionnaire (Mulugeta et al., 2022). There are numerous researches suggesting a positive correlation between improved self-care practices and lower hospital readmission rates among HF patients (Aljohani, 2023; Mulugeta et al., 2022; Skouri et al., 2024). Patients who partake in the prompted self-care methods have favorable outcomes and rarely need to be readmitted to the hospital.

Medical Record Review

The electronic medical record review (EMR) has been applied in Saudi heart failure studies to gather multiple items of clinical data (Aljabri, 2021; Mulugeta et al., 2022). This data consists of documented co-morbidities, laboratory results, medications prescribed, treatments received, and healthcare utilization episodes like hospitalizations and emergency visits.
One of the biggest advantages of EMR data is the ability to access objectively recorded clinical parameters, tests, and events, which reinforce and supplement subjective self-reported data provided by patients. Nevertheless, the uniformity and amount of EMR documentation may vary among institutions and providers, possibly limiting the availability of some data elements. Implementing common EMR data extraction rules with clear variable definitions, missing information handling procedures, and quality assessments ensures the credibility of EMR data collection.

Conclusion

This research study applies a comprehensive quasi-experimental design in order to investigate heart failure self-care behaviors, clinical results, including 30-day readmission rate, and related contributing factors among Saudi patients. Medical record reviews will be used as an essential tool to assess such parameters as clinical profiles and healthcare utilization patterns. Well-established procedures to guarantee reliable and valid measures of the essential variables using standardized tools and precise criteria will enhance the generalizability of the study results. In conclusion, the outcomes can guide the development of tailored self-care educational programs and those based on evidence-based care to improve the self-management of heart failure and the significant burden of hospital readmission among cardiac patients in Saudi Arabia.

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