Introduction
Hospitalized patients with heart diseases often experience fear of death, isolation from family and community, occupational challenges, and financial burdens, which can lead to anxiety and despair, and delay treatment progress and recovery. Another important factor for these patients is life expectancy, as it can improve physical condition and treatment tolerance. Many patients with congestive heart failure experience low levels of hope and high anxiety due to the lack of a definitive cure and the progressive nature of the disease, which can be addressed through self-management programs and enable patients to control their disease. Self-management increases patients’ knowledge of their disease, helps prevent further complications, and delays disease progression. Considering the importance of anxiety and hope in disease control and treatment adherence among these patients, this study aimed to design and implement an online self-management program and evaluate its impact on hope and anxiety in patients with congestive heart failure.

Materials and Methods
In this randomized clinical trial conducted in 2024, we enrolled 100 patients with congestive heart failure at hospitals affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, using convenience sampling. They were randomly assigned to intervention or control groups. Data collection tools included a sociodemographic checklist (age, gender, marital status, education level, occupation, time of heart failure diagnosis, comorbidities, medications used, monthly income, family history of heart disease, and other relevant factors), Eifert’s Cardiac Anxiety Questionnaire (CAQ), and the Miller Hope Scale (MHS). The intervention group received the self-management educational program for 6 weeks via WhatsApp based on Kern’s six-stage model. The self-management program covered various topics including understanding heart failure, causes and symptoms, treatment options, medication management, lifestyle modification, coping with challenges, and stress management. The collected data were analyzed using descriptive and statistical methods in SPSS software, version 19. 

Results
Implementing the self-management program reduced the level of anxiety (from 44.00±8.22 to 44.00±7.025) and improved hope (from 44.00±18.15 to 44.00±16.32). According to the paired t-test results, there was no significant difference in the mean CAQ score between the pre-test and post-test phases in the control group (P=0.486), but a significant decrease was observed in the intervention group (P<0.001). Similarly, the mean MHS scores did not show a significant difference between the pre-test and post-test in the control group (P=0.468), but a significant increase was observed in the intervention group (P<0.001). According to the results of the independent t-test, there was no statistically significant difference in the mean CAQ score between the control and intervention groups before the intervention (P=0.439), but after the intervention, a significant difference was reported, such that the intervention group showed a lower level of anxiety (P=0.004). In addition, the mean MHS score between the two groups before the intervention was not significantly different (P=0.976), but a statistically significant difference was observed in the post-test phase (P=0.021), with the intervention group having a higher score (Table 1). 



Conclusion 
The results of the present study showed that the online self-management educational program had a significant impact on the hope and cardiac anxiety of patients with congestive heart failure. It led to a significant decrease in the CAQ score and a significant increase in the MHS score. Therefore, the self-management education not only can improve the psychological and social functioning but also can prevent the progression of the physical symptoms of heart disease in patients. 

Ethical Considerations
Compliance with ethical guidelines
This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences Tehran, Iran (Code: IR.SBMU.RETECH.REC.1403.101), and was registered by the Iranian Registry of Clinical Trials (ID: IRCT20200727048221N1). 

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Marzieh Pazakian: Conceptualization, methodology, supervision, and writing the initial draft; Mahsa Bouzari: Conceptualization; Hanieh Molaei: Data collection and writing the initial draft; Maliheh Nasiri: Formal analysis and writing the initial draft; Fatemeh Saleh: Review & editing. All authors read and approved the final version of the manuscript.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the patients and the Clinical Research Development Unit of Loghman Hakim Hospital in Tehran, Iran, for their support and cooperation during the study.

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