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Research

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

Emma Sowden, Muhammad Hossain, Carolyn Chew-Graham, Tom Blakeman, Stephanie Tierney, Ian Wellwood, Francesca Rosa and Christi Deaton
British Journal of General Practice 2020; 70 (701): e880-e889. DOI: https://doi.org/10.3399/bjgp20X713477
Emma Sowden
National Institute for Health Research (NIHR) School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Roles: Research associate
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Muhammad Hossain
NIHR Applied Research Collaboration West Midlands, School of Primary, Community and Social Care, Keele University, Keele.
Roles: Health services researcher
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Carolyn Chew-Graham
NIHR Applied Research Collaboration West Midlands, School of Primary, Community and Social Care, Keele University, Keele.
Roles: Professor of general practice research
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Tom Blakeman
National Institute for Health Research (NIHR) School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Roles: Clinical senior lecturer in primary care
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Stephanie Tierney
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Roles: Researcher in evidence synthesis
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Ian Wellwood
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge.
Roles: Research associate
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Francesca Rosa
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge.
Roles: Research nurse
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Christi Deaton
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge.
Roles: Florence Nightingale Foundation clinical professor of nursing
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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.

  • comorbidity
  • disease management
  • heart failure
  • normalisation process theory
  • qualitative research
  • Received March 6, 2020.
  • Revision requested April 17, 2020.
  • Accepted May 19, 2020.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
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Understanding the management of heart failure with preserved ejection fraction: a qualitative multiperspective study
Emma Sowden, Muhammad Hossain, Carolyn Chew-Graham, Tom Blakeman, Stephanie Tierney, Ian Wellwood, Francesca Rosa, Christi Deaton
British Journal of General Practice 2020; 70 (701): e880-e889. DOI: 10.3399/bjgp20X713477

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Understanding the management of heart failure with preserved ejection fraction: a qualitative multiperspective study
Emma Sowden, Muhammad Hossain, Carolyn Chew-Graham, Tom Blakeman, Stephanie Tierney, Ian Wellwood, Francesca Rosa, Christi Deaton
British Journal of General Practice 2020; 70 (701): e880-e889. DOI: 10.3399/bjgp20X713477
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Keywords

  • comorbidity
  • disease management
  • heart failure
  • normalisation process theory
  • qualitative research

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Print ISSN: 0960-1643
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