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

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.

Clinicians’ and patients’ experiences of managing heart failure during the COVID-19 pandemic: a qualitative study

“…Interviews were conducted by three researchers (FF, MH, ES) who had established rapport with the interviewees through prior studies. (10)(11)(12) The same researchers familiarised, categorised and collated data into descriptive codes in an inductive approach; 50% of all interviews were double coded. All authors contributed to searching, reviewing and defining themes.…”

Diagnosis of patients with heart failure with preserved ejection fraction in primary care: cohort study

“…Cuthbert and colleagues 25 and our own research have shown that the proportion of patients included on a typical practice HF register is much lower than expected based on epidemiological data 26 and that these patients are more likely to have HFrEF 27 . Secondly, our qualitative work has demonstrated low awareness of HFpEF in primary care 9,28 . Lastly, there is variable access to HF specialist services for non‐HFrEF referrals to obtain a definitive diagnosis 7–9 …”

“…27 Secondly, our qualitative work has demonstrated low awareness of HFpEF in primary care. 9 , 28 Lastly, there is variable access to HF specialist services for non‐HFrEF referrals to obtain a definitive diagnosis. 7 , 8 , 9 …”

“…27 Secondly, our qualitative work has demonstrated low awareness of HFpEF in primary care. 9,28 Lastly, there is variable access to HF specialist services for non-HFrEF referrals to obtain a definitive diagnosis. [7][8][9] The challenge of HFpEF diagnosis using the standard clinical pathway has been observed in other studies.…”

Role of Primary Care in Management of Heart Failure Preserved Ejection Fraction (HFpEF): A Literature Review

“…The diagnosis of HFpEF is challenging particularly at the early stage of the disease where symptoms are nonspecific and can be caused by numerous non-cardiac conditions. 11 HFpEF is less well understood than HFrEF, with greater diagnostic difficulty and management uncertainty. 9 This is where to start using other diagnostic tools for the patient with the high-risk factor such as echocardiography, exercise stress testing, and coronary angiography.…”