Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study

Forsyth, Faye; Mant, Jonathan; Taylor, Clare; Hobbs, FD Richard; Chew‐Graham, Carolyn; Blakeman, Thomas; Sowden, Emma; Long, A. P.; Hossain, Muhammad Zakir; Edwards, Duncan; Deaton, Christi

doi:10.3399/bjgpopen19x101675

Cited by 12 publications

(14 citation statements)

References 41 publications

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“…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.…”

Section: Approachmentioning

confidence: 99%

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

et al. 2021

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BackgroundThe SARS-CoV-2 Coronavirus Disease (COVID-19) resulted in unprecedented societal and healthcare provision change that has been implemented at pace. Little is known about the indirect impacts of these changes and what the future effects may be.AimTo explore patients’ and clinicians’ experiences of managing heart failure (HF) during the COVID-19 pandemic.Design & settingQualitative study in three regions of the UK: Cambridgeshire, Greater Manchester and the West Midlands.MethodSemi-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.ResultsCompliance with the government guidance ‘Stay home, Protect the NHS, 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.ConclusionPerception 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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Section: Approachmentioning

confidence: 99%

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

et al. 2021

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“…Characterising patients with HFpEF in primary care is an essential step towards improving diagnosis and management, as well as recruiting into trials. This analysis presents baseline data from a longitudinal observational study that is a component of the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (Optimise HFpEF) study [14]. Patients were recruited based on a search of primary care HF registers for patients with no record of reduced ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

et al. 2021

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BackgroundMany patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record HF sub-type. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care.AimsTo describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted.Design and SettingBaseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England.MethodsA screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction. Baseline evaluation included cardiac, mental and physical function, clinical characteristics and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist.ResultsNinety-three (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79.3, 46% were female, 80% had hypertension, and 37% took 10 or more medications. Patients with HFpEF were more likely to be obese, pre-frail/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.ConclusionsPatients 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 well-being through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.

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“…An earlier study revealed that specialist nurses can greatly improve the effectiveness of health education (14). By managing high-risk factors and regularly pushing health education content for stroke patients using mHealth equipment, patients can observe the trend chart of their blood pressure indicators, which can better provide alerts for them.…”

Section: Discussionmentioning

confidence: 99%

“…The BHHM can provide more timely professional health interventions, allowing patients to obtain a better healthrelated knowledge (13). In previous studies, an Ambulatory Blood Pressure Monitor Mobile Health System was established to enable a patient to be aware of their risk in real-time, and this has improved the medication adherence with risk self-management (14). In the present study, the BHHM-led mobile health for secondary stroke prevention was established for post-hospital stroke patients, in order to determine its effectiveness.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of brain and heart health manager-led mHealth secondary stroke prevention

Wang¹,

Liu²,

Tian³

et al. 2020

Cardiovasc Diagn Ther

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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 selfmanagement 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 (F time =8.734, F group =172.075, and F interaction =11.363) was statistically significant (P<0.05). The self-health management ability at four time points during follow-up period (F time =115.09, F group =1,185.50, and F interaction =108.22) was also significantly different between these two groups. Furthermore, there was a statistically significant difference in compliance with medication at six months (χ 2 =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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Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study

Cited by 12 publications

References 41 publications

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

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

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

A randomized controlled trial of brain and heart health manager-led mHealth secondary stroke prevention

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