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Objective: The purpose of this study was to test the efficacy of a heart failure (HF) training program on patients' ability to recognize and respond to changes in HF symptoms. The primary aim was to compare event-free survival at 90 days., Methods: A total of 99 HF patients randomized to the HF symptom training intervention or usual care completed instruments about self-care (Self-Care of HF Index) and at baseline and 3 months. Demographic, clinical, and comorbidity data were collected by interview and chart review. Time to first event (death or a HF-related hospitalization) was tracked by electronic records and patient interview., Results: The sample was predominately male (67.7%), elderly (67.7 yrs ± 12.1) and Caucasian (88.9%). The intervention group reported more events but the difference was not significantly different (χ(2) = 1.18, p = 0.26). There was no difference in survival time between groups (χ(2) = 1.53, p = 0.216). In paired t-tests, the intervention group had significantly improved self-care maintenance, management and confidence scores (all p < 0.01). The usual care group had significantly improved self-care maintenance and management (both p < 0.01). Improvements in self-care maintenance and confidence were higher in the intervention group compared with usual care (18.0 vs. 12.9 points)., Conclusions: HF symptom awareness training appeared to have an early but not sustained benefit resulting in no difference in 90-day event-free survival. However, larger improvement in self-care maintenance and confidence scores in the intervention group compared to usual care is promising. Embedding meaningful symptom monitoring strategies in self-care maintenance interventions requires further investigation., (Copyright © 2013 Elsevier Inc. All rights reserved.)