Implementing an interactive tool in nurse-led support or therapeutic education for patients with heart failure: the EPOF four-families card game

Heart failure is a common and growing chronic syndrome that remains costly and is still too often managed late, partly because patients do not recognise early warning signs. In France, national campaigns promote the EPOF alert signs - E (shortness of breath), P (weight gain), O (oedema), F (fatigue) - to encourage earlier identification of decompensation. Nurses play a key role in patient support and therapeutic education (TPE), helping people identify symptoms, name them, and act at the right time.

To present a playful, structured card-game tool designed to strengthen recognition of EPOF warning signs and reinforce EPON lifestyle rules (Exercise, Weighing, medication adherence, No excess salt) during nurse-led support/TPE sessions.

In 2021, a heart failure remote-monitoring nurse designed a handmade "four families" card game. Four central cards (E-P-O-F) are placed on the table and "symptom/term" cards are distributed to participants. In turn, each participant matches cards to the relevant EPOF category and explains their choice, fostering discussion and reflection. Medical terms commonly found in clinical reports (e.g., dyspnoea, orthopnoea, lower-limb oedema, bendopnoea) are deliberately included to improve health literacy. In March 2025, co-development with the remote-monitoring partner Satelia supported the addition of illustrations, formal game rules, and professional printing. Dissemination started in the Occitanie region (June 2025) and then expanded nationally. A national survey of healthcare professionals is ongoing.

Since December 2025, the game has been used by more than 100 centres across France and integrated into TPE programmes. At Albi General Hospital, patients are generally receptive, report willingness to attend again, and the friendly atmosphere promotes trust, participation, and peer support. Post-session feedback suggests improved understanding and recall of EPOF warning signs with this interactive approach.

The EPOF Four-Families card game is a simple, reproducible, and engaging tool to support learning about decompensation warning signs and strengthen health literacy. Findings from the ongoing national survey will guide further improvement and development (EPON add-on, pocket reminder card, Braille adaptation, and a digital version).