Developing a core outcome set for patient-reported symptom monitoring to reduce hospital admissions for patients with heart failure

Abstract

Aims In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. Methods and results A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection. Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. Conclusion Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.

The use of virtual nominal groups in healthcare research: An extended scoping review

“…Within healthcare, topics were varied and included items such as improving care for inmate dementia [ 30 ], home rehabilitation for stroke survivors [ 49 ], COVID-19 vaccine rollout in pharmacies [ 51 ] barriers to testing lipids and achieving disease control in rheumatoid arthritis [ 56 , 57 ]. Patients were often central to the vNGT with topics including patient views on the treatment of osteoporosis [ 28 ], multiple myeloma [ 50 ] or osteoarthritis [ 43 ] and patient reported outcomes in heart failure [ 33 ].…”

Impact of a clinician-to-clinician electronic consultation in heart failure patients with previous hospital admissions

“…These telemedicine programmes may be of special interest in HF patients after an episode of hospitalization since those patients have a worse prognosis; telemedicine may provide a sustainable, cost-effective, and patient-centred approach to helping reduce rehospitalization in patients with HF. 5 , 6 , 11–13 , 15 …”

Impact on Accessibility to Care and Outcomes of a Clinician-to-Clinician Electronic Consultation Program in Heart Failure Patients with Previous Hospital Admissions: Implications for Heart Failure Care

“…These telemedicine programs may be of special interest in HF patients after an episode of hospitalization since those patients have a worse prognosis; telemedicine may provide a sustainable, cost-effective, and patient-centered approach to helping reduce rehospitalization in patients with HF [5,6,12,13,15,17].…”