Inclusion criteria: (1) Meeting the diagnostic and treatment criteria for AHF and confirmed diagnosis in the emergency department [16]; (2) Aged $>$18 years; (3) Availability of complete clinical data; (4) Absence of intellectual disability, cognitive impairment, or severe psychiatric illness, and the ability to understand and adhere to the care plan.

Exclusion criteria: (1) Not the first hospitalisation for AHF; (2) Physical disabilities impairing assessment of activity capacity or preventing effective participation in a collaborative educational program; (3) Comorbidities requiring emergent management of severe cardiovascular conditions, including but not limited to: acute coronary syndrome (unstable angina or myocardial infarction), severe valvular disease requiring urgent intervention, cardiogenic shock, or persistent ventricular tachycardia or ventricular fibrillation; (4) Concomitant infectious diseases; (5) Hepatic or renal dysfunction; (6) Serious systemic comorbidities expected to significantly affect prognosis or interfere with intervention assessment, such as uncontrolled severe chronic obstructive pulmonary disease (COPD), uncontrolled severe diabetes mellitus, or active autoimmune disease requiring immunosuppressive therapy; (7) History of prior cardiac surgery; (8) Malignant tumors; (9) Pregnant or lactating women.

A total of 110 patients with AHF admitted to Tongxiang First People’s Hospital between January 2022 and January 2024 were included in this retrospective cohort study. Based on clinical records, patients were retrospectively grouped according to the nursing interventions they received during hospitalisation at the HF centre. Specifically, they were assigned to the control group (n = 47; conventional education management model) and the observation group (n = 63; collaborative education management model involving both physicians and nurses). This study was approved by the institutional Ethics Review Committee of Tongxiang First People’s Hospital (Approval number: 2024-207) and conducted following the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants.

The control group received a conventional education management intervention, which included routine electrocardiograms and arterial blood gas monitoring every 15 $\pm$ 3 minutes, twice daily; assistance with sitting or semi-sitting positions for oxygen therapy, 10 $\pm$ 2 minutes each time, three times per day; and supervision of medication and infusion according to the orders by the physician, lasting 20 $\pm$ 5 minutes each session. Additionally, patients and their families were provided with a single session of AHF-related health education (20 $\pm$ 5 minutes) during the hospitalisation period to reduce adverse events. Following discharge, patients received monthly follow-ups (by telephone or outpatient visit) for six months.

The observation group received a physician-nurse collaborative health education management intervention, which differed from the standard care. Medical-nursing staffing and team organisation: Each team consisted of one cardiovascular specialist, one rehabilitation physician, one head nurse, six specialist nurses, and one psychologist. Volume assessment and management protocols were developed for HF patients, together with standardised documentation forms for examination indicators and precautions. The same medical-nursing team provided continuous care throughout hospitalisation, with defined responsibilities for each member to ensure clear task division and collaboration.

(1) Collaborative assessment and plan development: Upon admission, emergency department physicians and responsible nurses jointly performed a comprehensive evaluation of the patient’s condition using the “Standardised Examination Form for Acute Heart Failure Patients Upon Admission” (Supplementary Material 1), including vital signs, cardiac function indices, and biochemical parameters. Medical and nursing staff jointly discussed cases and performed collaborative ward rounds according to the “Procedure Specifications for Collaborative Ward Rounds in Acute Heart Failure” (Supplementary Material 2). Rounds were conducted twice weekly, lasting 40 $\pm$ 10 minutes each, to collectively develop treatment plans, dietary guidelines, exercise regimens, and rehabilitation protocols. Primary nurses were responsible for basic nursing care, specialised nursing interventions, psychological support, health education, rehabilitation nursing, and post-discharge guidance, working collaboratively with physicians to monitor patient conditions and implement diagnostic and therapeutic plans.

(2) Implementation of structured health education: Structured education was delivered using three complementary approaches:

Face-to-face education: Each session was conducted in a standardised education room after the condition of the patient had stabilised (post-surgery, or 24–48 hours before discharge), with each session lasting 20 $\pm$ 5 minutes. The teaching focused on reinforcing key knowledge of heart failure (aetiology, symptoms, compensatory mechanisms) and guiding patients to develop self-care behaviours to delay disease progression. A multidisciplinary team, including cardiologists and nurses, used the “Standardised Lecture Notes for Heart Failure Patients” (Supplementary Material 3) to explain personalised dietary principles (e.g., sodium intake targets, food choices, drug effects) and individualised exercise prescriptions (type, intensity, frequency, duration, risk warnings). Patients were trained to recognise early warning symptoms of acute heart failure attacks, perform basic emergency responses (e.g., positioning, oxygen use, administration of emergency medication), and follow standardised response procedures for unplanned situations such as missed doses or abnormal blood pressure. A “Home Emergency Guide for Acute Heart Failure” (Supplementary Material 4) was provided. Patients also received a standardised “Self-management Log for Heart Failure” with instructions for daily recording of vital signs (resting heart rate, blood pressure upon waking, weight), types and durations of activities, medication use (names, dosages, and times of all medications), fluid balance (24-hour fluid intake, urine output), and adjustments in diuretic doses, sodium restrictions, and activity levels under special circumstances (e.g., symptom changes, dining out, social activities). Nurses reviewed logs weekly and provided feedback.

Illustrated materials: A concise, portable “Self-Management Handbook for Heart Failure” (Supplementary Material 5) was designed by specialists and rehabilitation physicians. It summarises key disease knowledge, medication precautions, dietary adjustment principles (e.g., low-salt and low-fat diets), and rehabilitation exercises, allowing patients to consult conveniently at any time. Nurses distributed the handbook and guided patients through a 10 $\pm$ 2-minute review.

Video education: Short modular videos (2–3 minutes each) combine animations, live demonstrations, and expert narration to explain disease mechanisms, emergency management, lifestyle strategies, and rehabilitation practices. Patients watched 3–4 modules daily (total duration: 8–12 minutes), which increased engagement and improved comprehension (https://www.pule.com/xinlishuaijie/video/pn1/).

(3) Psychological intervention: Given the severity of illness and frequent comorbid anxiety or depression in patients with AHF, a multidisciplinary medical team delivered a standardised psychological intervention protocol within 24 hours of hospital admission. This single session integrated empathetic active listening, structured psychological assessment, and cognitive-behavioural guidance, lasting 12–18 minutes. Each session lasts approximately 15 $\pm$ 3 minutes (on the first day of admission). Based on the assessment results, additional interventions such as cognitive-behavioural therapy (CBT) and relaxation training (25 $\pm$ 5 minutes each session, twice weekly) were jointly implemented by physicians and nurses to improve the mental health and well-being of the patients.

(4) Discharge nursing guidance: Personalised follow-up records and cyclic monitoring protocols with scheduled observation intervals were developed for each patient at discharge.

(5) Post-discharge follow-up: After patients were discharged, physicians and nurses conducted at least one follow-up per month (by phone or outpatient clinic) for a total of six months. Follow-up included a systematic assessment of cardiac function status, medication adherence, and lifestyle changes. At the same time, treatment and nursing plans were adjusted as needed to enhance treatment adherence, reduce readmission rates, and optimise treatment outcomes.

(1) Baseline data characteristics: Baseline information for all patients was obtained from the electronic medical record system before the nursing intervention. Variables included gender, age, educational level, history of hypertension, history of diabetes, New York Heart Association (NYHA) cardiac function classification, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level.

(2) Self-care ability assessment: The Self-Care of Heart Failure Index (SCHFI) was used to evaluate self-management behaviours at baseline and six months post-discharge in both groups [17]. The scale comprises three dimensions: (i) Self-care maintenance, which evaluates medication adherence, dietary management, exercise routines, and symptom monitoring; (ii) Self-care management, which assesses the ability to recognise symptoms and respond promptly; (iii) Self-care confidence, which measures confidence in executing behaviours. Items were rated on a 4-point Likert scale, with dimension scores standardised to a 0–100 scale. A total score of $\ge$70 points indicated adequate self-care standards.

(3) Psychological status assessment: The Self-Rating Depression Scale (SDS) [18] and the Self-Rating Anxiety Scale (SAS) [19] were used at baseline and six months post-discharge to evaluate the psychological status of patients. Each scale consists of 20 items scored on a 4-point scale, yielding a total score range of 20–80. For the SDS, a score $\ge$50 indicated depressive symptoms, while for the SAS, a score $\ge$53 indicated the presence of anxiety symptoms.

(4) Quality of life assessment: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was administered at baseline and six months post-discharge [20]. The MLHFQ includes 21 items covering three domains: physical (8 items), emotional (5 items), and other relevant aspects (8 items). Each item was scored on a 0–5 Likert scale, producing a total score between 0 and 105. Higher scores indicate poorer quality of life.

(5) NYHA functional classification: Cardiac function was evaluated at baseline and six months post-discharge according to the NYHA functional classification system [21]: Class I, no limitation of physical activity, symptoms of HF occur only during strenuous exercise; Class II, mild limitation of physical activity, symptoms develop during ordinary physical activity but resolve completely at rest; Class III, marked limitation of physical activity, symptoms are triggered by minimal exertion (e.g., light household tasks) and persist partially at rest; Class IV, severe limitation, symptoms are present at rest and worsen with any physical activity.

(6) Biomarker analysis: NT-proBNP levels were compared between the two groups. Fasting venous blood samples were collected for NT-proBNP determination at baseline and six months post-discharge.

(7) Clinical outcome measures: Clinical outcomes included: (i) Readmission rate, recorded via telephone follow-up for any readmission event within 3 months post-discharge; (ii) Length of hospital stay, defined as the total hospital days from admission until discharge criteria were met; (iii) Adverse event incidence, obtained from the electronic medical records and including arrhythmias, pneumonia, and acute angina pectoris.

Data were analysed using SPSS Version 26.0 (IBM Corporation, Armonk, NY, USA). The Shapiro-Wilk test and Kolmogorov-Smirnov test were used to test the normality of the variables. Normally distributed data were tested for homogeneity of variance using Levene’s test and were expressed as mean $\pm$ standard deviation ($\overline{x}$ $\pm$ s). Between-group comparisons were conducted using independent samples t-tests, and within-group comparisons were performed using paired-samples t-tests. Non-normally distributed data were presented as median with interquartile range (Q1, Q3), with between-group comparisons performed using the Mann-Whitney U test and within-group comparisons via the Wilcoxon signed-rank test. Categorical variables were summarised as frequencies and percentages [n (%)] and analysed using the $\chi$² test or Fisher’s exact test as appropriate. A p-value 0.05 was considered statistically significant.

As shown in Fig. 1, a total of 110 patients with AHF were enrolled according to the inclusion and exclusion criteria, comprising 47 in the control group and 63 in the observation group. Baseline clinical characteristics of the two groups are summarised in Table 1. The mean age was 73.92 $\pm$ 5.21 years in the observation group and 73.96 $\pm$ 5.46 years in the control group, with no significant difference between the two groups (p $>$ 0.05). Similarly, no statistically significant differences were observed between the two groups in gender distribution, education level, history of hypertension, history of diabetes, NYHA classification, or NT-proBNP levels (p $>$ 0.05).

Fig. 1.

Flow chart of patient selection.

Prior to the nursing intervention, SCHFI scores across all dimensions were comparable between the two groups, with no statistically significant difference (p $>$ 0.05). Six months after discharge, SCHFI scores improved significantly in both groups (p 0.05), with the observation group showing markedly higher scores across all dimensions compared with the control group (p 0.001) (Table 2).

At baseline, SDS and SAS scores exhibited no statistically significant differences between the two groups (p $>$ 0.05). After six months, both groups demonstrated significant reductions in SDS and SAS scores (p 0.001); however, the observation group showed significantly lower scores than the control group, indicating greater improvement in emotional status (p 0.001) (Table 3).

Before the nursing intervention, no significant differences were observed in MLHFQ scores across all domains between the two groups (all p $>$ 0.05). At six months post-discharge, both groups experienced significant within-group reductions in MLHFQ scores (p 0.05); whereas the observation group exhibited significantly lower scores than the control group across all domains, reflecting superior improvements in quality of life (p 0.001) (Table 4).

At baseline, there was no statistically significant difference in the distribution of NYHA functional classes between the two groups (p $>$ 0.05). Six months post-discharge, the observation group demonstrated a significantly more favourable NYHA functional class profile compared with the control group (p 0.05) (Table 5).

Before the nursing intervention, there was no statistically significant difference in NT-proBNP levels between the two groups (p $>$ 0.05). At six months post-discharge, NT-proBNP levels decreased significantly in the observation group (p 0.001); moreover, the observation group exhibited significantly lower NT-proBNP levels compared with the control group (p 0.05) (Table 6).

Following the nursing intervention, the mean length of hospital stay in the observation group was 10.20 $\pm$ 1.58 days, significantly shorter than that of the control group (13.13 $\pm$ 2.69 days, p 0.001). The three-month readmission rate in the observation group was 7.94%, significantly lower than that in the control group (21.28%, p 0.05), as shown in Table 7. In terms of adverse events, the combined incidence of arrhythmia, angina pectoris, and pulmonary infection in the observation group was significantly lower than that in the control group (p 0.05) (Table 8).