Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives

Muhammad Z Hossain, Carolyn A Chew-Graham, Emma Sowden, Tom Blakeman, Ian Wellwood, Stephanie Tierney, Christi Deaton, Muhammad Z Hossain, Carolyn A Chew-Graham, Emma Sowden, Tom Blakeman, Ian Wellwood, Stephanie Tierney, Christi Deaton

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.

Trial registration: ClinicalTrials.gov NCT03617848.

Keywords: General practitioners; HFpEF; heart failure; primary care; qualitative methods.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CC-G, TB and IW have received funding from NIHR and other external funding bodies. CD has received grants from NIHR School for Primary Care Research, NIHR and Charities.

Figures

Figure 1.
Figure 1.
HFpEF GP model.

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Source: PubMed

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