The purpose of this clinical study is to evaluate whether individualized discharge education is effective in treating patients identified as high-risk based on the LACE index after a myocardial infarction. Additionally, information will be gathered regarding the safety and outcomes of this education. The key questions the study aims to answer are: Does individualized discharge education reduce hospital readmission rates for patients identified as high-risk after a myocardial infarction? Does this education improve patients' treatment adherence, self-care levels, and quality of life? Researchers will compare the effectiveness of individualized discharge education against routine care. Participants will:Receive individualized discharge education prior to discharge if they meet the high-risk criteria, and receive a comprehensive educational brochure. Be followed up via telephone three days a week while at home to monitor their care practices and hospital visits. Participate in follow-up assessments at the 1st month (Follow-up 1) and 3rd month (Follow-up 3) to complete the Coronary Heart Disease Self-Care Inventory and the HeartQoL scale.
This study is a controlled research project examining the impact of individualized discharge education on clinical outcomes in patients identified as "high-risk" following a myocardial infarction (MI) using the LACE index. The study aims to determine the role of patient education and follow-up during the post-cardiovascular event care process in reducing hospital readmission rates. The fundamental interventions and processes to be carried out within the scope of the research are as follows:Risk Classification: Prior to discharge, patients treated in the cardiology clinic will be assessed using the LACE index, which includes length of hospital stay, acuity of admission, comorbidities, and emergency department visits within the previous 6 months. Patients with a LACE score of 10 or higher will be classified as "high-risk" and included in the study. Educational Intervention: The intervention group will receive a structured discharge education program tailored to the patients' clinical characteristics, educational levels, and risk profiles. During the education process, a comprehensive brochure containing all relevant information will be provided. The control group will continue to receive the hospital's standard routine care. Monitoring and Follow-up: Patients will be followed for 3 months during the post-discharge period. Patients in the intervention group will be contacted by telephone 3 days a week while at home to monitor their self-care practices and hospital visits. Assessment Points: Research data will be collected before discharge (Follow-up 0), at the 1st month post-discharge (Follow-up 1), and at the 3rd month (Follow-up 3). During this process, patients' readmission statuses will be recorded, and clinical changes will be compared using the Percutaneous Coronary Intervention Information Needs Scale (NCPI-10), the Self-Care of Coronary Heart Disease Inventory (SC-CHDI), and the HeartQoL scale. Data Analysis: The collected data will be subjected to statistical analysis using SPSS 29 software to evidence-based demonstrate the effectiveness of individualized nursing education in improving patient outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
82
Education will cover the following topics: Disease Knowledge and Process Management: Definition of myocardial infarction, long-term management of the disease, risk of recurrence, and recognition of complication symptoms. Adherence to Medication Therapy: Regular use of medications, their effects, and methods of administration. Management of Comorbidities: Monitoring and managing existing co-occurring conditions as part of the overall care plan. Self-Care and Lifestyle Modifications: Nutrition: Adopting low-fat dietary habits that support heart health. Physical Activity: The importance of regular exercise and a safe activity plan. Risk Factor Control: Smoking cessation and avoiding smoke-filled environments, weight control, and blood pressure monitoring. Symptom Management: Recognizing potential symptoms and the necessary actions to take in such situations . Psychosocial Support: Strategies for managing disease-related stress and improving quality of life.
Adıyaman University
Adıyaman, Besni, Turkey (Türkiye)
LACE index
LACE (Length of stay, Acuity of admission, Comorbidity, Emergency department visits) Index: The LACE index was first developed by van Walraven et al. to estimate the risk of unplanned readmission or death within 30 days of hospital discharge in medical and surgical patients. The model was derived and validated based on administrative data with a C-statistic of 0.68. The model includes length of hospital stay (L), severity of admission (A), comorbidities of patients (C), and the number of emergency department visits within six months prior to admission (E). Scores ranging from "0" to "19" and greater than ten are considered a high risk for 30-day readmission. Higher scores indicate a high risk of readmission. This tool is widely used primarily due to its simplicity and usability in daily clinical practice.
Time frame: Day 1
Percutaneous Coronary Intervention Information Needs Scale (NCPI-10)
Percutaneous Coronary Intervention Information Needs Scale (NCPI-10): This scale is a 10-item scale that assesses the information needs of patients undergoing percutaneous coronary intervention (PCI) . The Turkish validity and reliability study was conducted by Tüllüce et al. in 2025. A four-point Likert scale was used to answer all items in the scale. The total score of each result is between 10-40. As the importance level score of the information need increases, the importance level for the patient increases. As the level of fulfillment of the information need score increases, the level of fulfillment of the needs increases. The Cronbach alpha internal consistency coefficient of the scales was found to be 0.98 for the importance level of the information need and 0.98 for the degree of fulfillment.
Time frame: Day 1
The Self-Care of Coronary Heart Disease Inventory (SC-CHDI)
The Self-Care of Coronary Heart Disease Inventory (SC-CHDI) was developed by Dickson et al. to assess the self-care levels of individuals with coronary heart disease. Its Turkish validity and reliability study was conducted by Bayrak and Oğuz (2020). The scale consists of 22 items and three sub-dimensions: maintaining self-care (10 items), managing self-care (6 items), and self-care confidence (6 items). Items are generally scored on a Likert scale from 1=never, 2=sometimes, 3=frequently, and 4=always, with some items in the self-care management sub-dimension being rated between 0 and 4. A total score is not obtained from the scale; each sub-dimension is evaluated separately, and higher scores indicate a better level of self-care. In the Turkish adaptation study, the Cronbach's alpha coefficients of the scale were found to be 0.63 for maintaining self-care, 0.76 for managing self-care, and 0.95 for self-care confidence.
Time frame: Day 1
Heart Quality of Life (HeartQoL) Scale
Heart Quality of Life (HeartQoL) Scale: The Heart Quality of Life (HeartQoL) Scale was developed to measure quality of life in individuals with ischemic heart disease . A Turkish validity and reliability study was conducted by Duğan \& Bektaş in 2020. The original scale included patients with angina pectoris, myocardial infarction, and ischemic heart failure within ischemic heart disease. The scale consists of 14 items, divided into two sub-dimensions: physical (10 items; 1, 2, 3, 4, 5, 6, 7, 8, 13, 14) and emotional characteristics (4 items; 9, 10, 11, 12). Each item in the HeartQoL Scale is scored between 0 and 3; 3 represents "no discomfort" and 0 represents "very discomfort". In the evaluation of the scale, high scores indicate the absence of dysfunction. The Cronbach's alpha reliability coefficient was found to be 0.88 overall, and between 0.74 and 0.87 in its sub-dimensions.
Time frame: Day 1
Personal Information Form
Personal Information Form: Prepared by researchers through a literature review, this form will include 22 questions covering socioeconomic and disease information, as well as systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglycerides, HDL, LDL, and BMI values.
Time frame: Day 1
The Self-Care of Coronary Heart Disease Inventory (SC-CHDI)
The Self-Care of Coronary Heart Disease Inventory (SC-CHDI) was developed by Dickson et al. to assess the self-care levels of individuals with coronary heart disease. Its Turkish validity and reliability study was conducted by Bayrak and Oğuz (2020) . The scale consists of 22 items and three sub-dimensions: maintaining self-care (10 items), managing self-care (6 items), and self-care confidence (6 items). Items are generally scored on a Likert scale from 1=never, 2=sometimes, 3=frequently, and 4=always, with some items in the self-care management sub-dimension being rated between 0 and 4. A total score is not obtained from the scale; each sub-dimension is evaluated separately, and higher scores indicate a better level of self-care. In the Turkish adaptation study, the Cronbach's alpha coefficients of the scale were found to be 0.63 for maintaining self-care, 0.76 for managing self-care, and 0.95 for self-care confidence.
Time frame: Day 1, first month and third month
Heart Quality of Life (HeartQoL) Scale: The Heart Quality of Life (HeartQoL) Scale
Heart Quality of Life (HeartQoL) Scale: The Heart Quality of Life (HeartQoL) Scale was developed to measure quality of life in individuals with ischemic heart disease . A Turkish validity and reliability study was conducted by Duğan \& Bektaş in 2020. The original scale included patients with angina pectoris, myocardial infarction, and ischemic heart failure within ischemic heart disease. The scale consists of 14 items, divided into two sub-dimensions: physical (10 items; 1, 2, 3, 4, 5, 6, 7, 8, 13, 14) and emotional characteristics (4 items; 9, 10, 11, 12). Each item in the HeartQoL Scale is scored between 0 and 3; 3 represents "no discomfort" and 0 represents "very discomfort". In the evaluation of the scale, high scores indicate the absence of dysfunction. The Cronbach's alpha reliability coefficient was found to be 0.88 overall, and between 0.74 and 0.87 in its sub-dimensions .
Time frame: Day 1, first month and third month
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