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Forsyth F, Deaton C. In memory of John Sharpley: a patient with HFpEF who really made a difference. Eur J Cardiovasc Nurs 2024; 23:e82-e83. [PMID: 38660971 DOI: 10.1093/eurjcn/zvae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 PB7001, 3000 Leuven, Belgium
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
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Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
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Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Pearson CR, Forsyth F, Khair E, Sowden E, Borja Boluda S, Deaton C. 'Keeping the plates spinning': a qualitative study of the complexity, barriers, and facilitators to caregiving in heart failure with preserved ejection fraction. Eur J Cardiovasc Nurs 2023; 22:141-148. [PMID: 35714068 DOI: 10.1093/eurjcn/zvac027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/12/2022]
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases; yet remains poorly understood, diagnosed, and managed, which adds complexity to the carer role. No study to date has investigated the experiences of informal carers of people with HFpEF. The aim of this study was to explore the role and experiences of informal carers of people with HFpEF. METHODS AND RESULTS A qualitative study using semi-structured interviews involving carers alone, patients alone, or carer/patient dyads. The interviews were part of a larger programme of research in HFpEF. Participants were recruited from three regions of England. Interviews were recorded, transcribed verbatim, and analysed thematically. Twenty-two interviews were conducted with 38 participants, 17 were informal carers. Three inter-related themes were identified: Theme 1, the complex nature of informal caregiving ('spinning plates'); Theme 2, the barriers to caregiving ('the spinning falters'); and Theme 3, the facilitators of caregiving ('keeping the plates spinning'). CONCLUSIONS Informal carers play an important role in supporting people with HFpEF. The experience of caregiving in HFpEF is similar to that described for Heart Failure with reduced Ejection Fraction, but complicated by challenges of limited information and support specific to HFpEF, and high burden of multi-morbidity. Healthcare providers should assess the needs of informal carers as part of patient care in HFpEF. Carers and patients would benefit from improved information and co-ordinated management of HFpEF and multi-morbidities. Helping carers 'keep the plates spinning' will require innovative approaches and co-ordination across the care continuum.
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Affiliation(s)
- Clare R Pearson
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, Cambridge, UK
| | - Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, Cambridge, UK
| | - Eva Khair
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, Cambridge, UK.,School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Emma Sowden
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | | | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, East Forvie, Cambridge Biomedical Campus, Cambridge CB2 0SR, Cambridge, UK.,Department of Medicine, Cambridge University Hospitals, Cambridge, UK
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Forsyth F, Mulrennan S, Burt J, Hartley P, Kuhn I, Lin H, Mant J, Tan S, Zhang R, Deaton C. What dietary interventions have been tested in heart failure with preserved ejection fraction? A systematic scoping review. Eur J Cardiovasc Nurs 2023; 22:126-140. [PMID: 35816028 DOI: 10.1093/eurjcn/zvac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022]
Abstract
AIMS To determine what dietary interventions have been tested in heart failure with preserved ejection fraction (HFpEF), the modulation method, and outcomes employed and to summarize any evidence for benefit. METHODS AND RESULTS We performed key word searches in five bibliographic databases from 2001 to 2021, to identify randomized or experimental dietary interventions tested in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarized according to population, intervention, comparator, outcome categories and intervention complexity was assessed. Twenty-five clinical investigations were retrieved; only 10 (40%) were conducted exclusively in HFpEF; the remainder enrolled mixed HF samples. Most studies employed either highly tailored prescribed diets (n = 12, 48%) or dietary supplementation (n = 10, 40%) modalities. Dietary pattern interventions (n = 3, 12%) are less well represented in the literature. CONCLUSION Heterogeneity made pooling studies challenging. Better reporting of baseline characteristics and the use of standardized HF lexicon would ensure greater confidence in interpretation of studies involving mixed HF populations. The field would benefit greatly from explicit reporting of the biological mechanism of action (e.g. the causal pathway) that an intervention is designed to modulate so that studies can be synthesized via their underlying mechanism of action by which diet may affect HF. An extension of the current set of core outcomes proposed by the European Society of Cardiology Heart Failure Association would ensure dietary clinical endpoints are more consistently defined and measured. REGISTRATION PROSPERO: CRD42019145388.
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Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Sandra Mulrennan
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Peter Hartley
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.,Physiotherapy Department, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Helen Lin
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Sapphire Tan
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Roy Zhang
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
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Hossain MZ, Chew-Graham CA, Sowden E, Blakeman T, Wellwood I, Tierney S, Deaton C. Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives. Chronic Illn 2022; 18:410-425. [PMID: 33401942 PMCID: PMC9163769 DOI: 10.1177/1742395320983871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). METHODS Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. RESULTS Themes presented reflect four inter-related challenges: GPs' 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. DISCUSSION HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.
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Affiliation(s)
- Muhammad Z Hossain
- Faculty of Medicine and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Emma Sowden
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis. BJGP Open 2021; 5:BJGPO.2021.0094. [PMID: 34465577 PMCID: PMC9447293 DOI: 10.3399/bjgpo.2021.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background Many patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record heart failure (HF) subtype. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care. Aim To describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted. Design & setting Baseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England. Method A screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction (EF). Baseline evaluation included cardiac, mental and physical function, clinical characteristics, and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist. Results In total, 93 (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79 years, 46% were female, 80% had hypertension, and 37% took ≥10 medications. Patients with HFpEF were more likely to be obese, pre-frail or frail, report more dyspnoea and fatigue, were more functionally impaired, and less active than patients in whom HFpEF was refuted. Few had attended cardiac rehabilitation. Conclusion Patients with confirmed HFpEF had frequent multimorbidity, functional impairment, frailty, and polypharmacy. Although comorbid conditions were similar between people with and without HFpEF, the former had more obesity, symptoms, and worse physical function. These findings highlight the potential to optimise wellbeing through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.
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Forsyth F, Brimicombe J, Cheriyan J, Edwards D, Hobbs FR, Jalaludeen N, Mant J, Pilling M, Schiff R, Taylor CJ, Zaman MJ, Deaton C, Chakravorty M, Maclachlan S, Kane E, Odone J, Thorley N, Borja‐Boluda S, Wellwood I, Sowden E, Blakeman T, Chew‐Graham C, Hossain M, Sharpley J, Gordon B, Taffe J, Long A, Aziz A, Swayze H, Rutter H, Schramm C, MacDonald S, Papworth H, Smith J, Needs C, Cronk D, Newark C, Blake D, Brown A, Basuita A, Gayton E, Glover V, Fox R, Crawshaw J, Ashdown H, A'Court C, Ayerst R, Hernandez‐Diaz B, Knox K, Wooding N, Wanninayake S, Keast C, Jones A, Brown K, Gaw M, Thomas N, Dixon S, Angeleri‐Rand E. Diagnosis of patients with heart failure with preserved ejection fraction in primary care: cohort study. ESC Heart Fail 2021. [PMCID: PMC8712851 DOI: 10.1002/ehf2.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure (HF), but low awareness and diagnostic challenges hinder identification in primary care. Our aims were to evaluate the recruitment and diagnostic strategy in the Optimise HFpEF cohort and compare with recent recommendations for diagnosing HFpEF. Methods and results Patients were recruited from 30 primary care practices in two regions in England using an electronic screening algorithm and two secondary care sites. Baseline assessment collected clinical and patient‐reported data and diagnosis by history, assessment, and trans‐thoracic echocardiogram (TTE). A retrospective evaluation compared study diagnosis with H2FPEF score and HFA‐PEFF diagnostic algorithm. A total of 152 patients (86% primary care, mean age 78.5, 40% female) were enrolled; 93 (61%) had HFpEF confirmed. Most participants had clinical features of HFpEF, but those with confirmed HFpEF were more likely female, obese, functionally impaired, and symptomatic. Some echocardiographic findings were diagnostic for HFpEF, but no difference in natriuretic peptide levels were observed. The H2FPEF and HFA‐PEFF scores were not significantly different by group, although confirmed HFpEF cases were more likely to have scores indicating high probability of HFpEF. Conclusions Patients with HFpEF in primary care are difficult to identify, and greater awareness of the condition, with clear diagnostic pathways and specialist support, are needed. Use of diagnostic algorithms and scores can provide systematic approaches to diagnosis but may be challenging to apply in older multi‐morbid patients. Where diagnostic uncertainty remains, pragmatic decisions are needed regarding the value of additional testing versus management of presumptive HFpEF.
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Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - James Brimicombe
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine University of Cambridge School of Clinical Medicine Cambridge UK
| | - Duncan Edwards
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Navazh Jalaludeen
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine University of Cambridge School of Clinical Medicine Cambridge UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Mark Pilling
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
| | - Rebekah Schiff
- Department of Ageing and Health Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Clare J. Taylor
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - M. Justin Zaman
- Department of Cardiology West Suffolk Hospital Bury St Edmonds UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge School of Clinical Medicine East Forvie, Cambridge Biomedical Campus Cambridge CB2 0SR UK
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Clinicians' and patients' experiences of managing heart failure during the COVID-19 pandemic. BJGP Open 2021; 5:BJGPO.2021.0115. [PMID: 34353790 PMCID: PMC9447295 DOI: 10.3399/bjgpo.2021.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), resulted in unprecedented societal and healthcare provision change, which has been implemented at pace. Little is known about the indirect impacts of these changes and what the future effects may be. Aim To explore patients’ and clinicians’ experiences of managing heart failure (HF) during the COVID-19 pandemic. Design & setting Qualitative study in three regions of the UK: Cambridgeshire, Greater Manchester, and the West Midlands. Method Semi-structured interviews (n = 30) were conducted with older adults with established HF and healthcare providers from primary and secondary health services involved in their care. Interviews were analysed thematically. Results Compliance with the government guidance ‘Stay at home, protect the NHS, and save lives’ during the COVID-19 pandemic, and perceptions relating to risk from COVID-19 and underlying morbidity, drove ‘being careful’ behaviours and organisational changes. Enacting behavioural change and implementing organisational change resulted in opportunities and challenges for health and healthcare practice. Conclusion Perception of risk led to significant behavioural and organisational change during the pandemic. Some changes described by both patients and clinicians, such as enhanced relationships and self-monitoring, present as opportunities, and consideration should be given as to how to maintain or develop these. Equally, indirect impacts of COVID-19 and the associated lockdown, such as disengagement and withdrawal, and the fallout from reluctance to access health services, should be acknowledged and interventions to address these challenges are needed.
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Understanding the management of heart failure with preserved ejection fraction: a qualitative multiperspective study. Br J Gen Pract 2020; 70:e880-e889. [PMID: 33139334 DOI: 10.3399/bjgp20x713477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
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.
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Wang S, Li Y, Tian J, Peng X, Yi L, Du C, Feng C, Liu C, Deng R, Liang X. A randomized controlled trial of brain and heart health manager-led mHealth secondary stroke prevention. Cardiovasc Diagn Ther 2020; 10:1192-1199. [PMID: 33224743 DOI: 10.21037/cdt-20-423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study explores the effect of brain and heart health manager (BHHM)-led stroke secondary prevention on blood pressure, and in improving the self-management ability of stroke patients. The BHHM has not been reported. Methods A total of 200 stroke patients, who were discharged from our hospital, were randomized into two groups at a 1:1 ratio: intervention group and control group. Patients in the control group were followed up for six months via telephone, while patients in the experimental group were followed up for six months using the BHHM-led mHealth follow-up. The primary outcomes were systolic blood pressure (BP) and self-management ability at 3, 6, 9 and 12 months, while the secondary outcomes included medication adherence, the body mass index (BMI), and blood low-density lipoprotein. Results The systolic BP between these two groups at four time points (Ftime =8.734, Fgroup =172.075, and Finteraction =11.363) was statistically significant (P<0.05). The self-health management ability at four time points during follow-up period (Ftime =115.09, Fgroup =1,185.50, and Finteraction =108.22) was also significantly different between these two groups. Furthermore, there was a statistically significant difference in compliance with medication at six months (χ2=37.616, P=0.000). However, after one year, there were no significant differences in BMI (t=0.214, P=0.644), total cholesterol (t=0.56, P=0.837), and low-density lipoprotein (t=0.042, P=0.455). Conclusions The BHHM-led mHealth follow-up is an effective method for managing BP and improving the self-care ability. Furthermore, this approach has no obvious effect on the management of BMI and blood low-density lipoprotein. A potential signal of efficacy with the intervention was observed.
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Affiliation(s)
- Shasha Wang
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Ying Li
- Department of Hematology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Jishu Tian
- Department of Nursing, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Xiaoqiong Peng
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Ling Yi
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Cuiping Du
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Changmei Feng
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Chunmei Liu
- Department of First Aid, Chongqing Three Gorges Medical College, Chongqing, China
| | - Rong Deng
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Xianju Liang
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
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