Understanding the management of heart failure with preserved ejection fraction : A qualitative multiperspective study

Journal article


Sowden, Emma, Blakeman, Thomas, Hossain, Muhammad Z, Chew-Graham, Carolyn A, Tierney, Stephanie, Wellwood, Ian, Rosa, Francesca and Deaton, Christi. (2020). Understanding the management of heart failure with preserved ejection fraction : A qualitative multiperspective study. British Journal of General Practice. 70(701), pp. 880-889. https://doi.org/10.3399/bjgp20X713477
AuthorsSowden, Emma, Blakeman, Thomas, Hossain, Muhammad Z, Chew-Graham, Carolyn A, Tierney, Stephanie, Wellwood, Ian, Rosa, Francesca and Deaton, Christi
Abstract

Background
About half of all people with heart failure have heart failure with preserved ejection fraction (HFpEF), in which the heart is stiff. This type of heart failure is more common in older people with a history of hypertension, obesity, and diabetes mellitus. Patients with HFpEF are often managed in primary care, sometimes in collaboration with specialists. Knowledge about how best to manage this growing population is limited, and there is a pressing need to improve care for these patients.

Aim
To explore clinicians’ and patients’/carers’ perspectives and experiences about the management of HFpEF to inform the development of an improved model of care.

Design and setting
A multiperspective qualitative study involving primary and secondary care settings across the east of England, Greater Manchester, and the West Midlands.

Method
Semi-structured interviews and focus groups were conducted. Transcribed data were analysed using framework analysis and informed by the normalisation process theory (NPT).

Results
In total, 50 patients, nine carers/relatives, and 73 clinicians were recruited. Difficulties with diagnosis, unclear illness perceptions, and management disparity were identified as important factors that may influence management of HFpEF. The NPT construct of coherence reflected what participants expressed about the need to improve the identification, understanding, and awareness of this condition in order to improve care.

Conclusion
There is a pressing need to raise the public and clinical profile of HFpEF, develop a clear set of accepted practices concerning its management, and ensure that systems of care are accessible and attuned to the needs of patients with this condition.

Keywordscomorbidity; disease management; heart failure; normalisation process theory; qualitative research
Year2020
JournalBritish Journal of General Practice
Journal citation70 (701), pp. 880-889
PublisherRoyal College of General Practitioners
ISSN1478-5242
Digital Object Identifier (DOI)https://doi.org/10.3399/bjgp20X713477
Scopus EID2-s2.0-85096946955
Research or scholarlyResearch
Page range880-889
FunderNational Institute for Health Research (NIHR)
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online03 Nov 2020
Publication process dates
Accepted19 May 2020
Deposited25 Aug 2022
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