Aims To investigate how Heart Failure with preserved Ejection Fraction, within the context of limited clinical services, impacts upon patients’ lives. Methods & Results Secondary thematic analysis informed by the Cumulative Complexity Model (CCM), of interview transcripts from 77 people diagnosed with HFpEF and their carers. Four themes corresponding to the core concepts of workload, capacity, access and outcome described in the CCM were generated. Theme 1: Shouldering a Heavy Workload, described the many tasks expected of people living with HFpEF. Theme 2: The Multiple Threats to Capacity described how patients and carers strived to engage with this work, but were often faced with multiple threats such as symptoms and mobility limitations. Deficient Illness Identity (Theme 3) reflects how HFpEF either was not recognised or was perceived as a more benign form of HF and therefore afforded less importance or priority. These themes contributed to a range of negative physical, social and psychological outcomes and the perception of loss of control described in Theme 4: Spiraling Complexity. Conclusions The constellation of HFpEF, multimorbidity and aging creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. Patients' recollections of their interactions with health professionals suggest there is widespread misunderstanding of HFpEF, which can prohibit access to care that could potentially reduce or prevent deterioration.

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