Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

Glogowska, Margaret; Simmonds, Rosemary; McLachlan, Sarah; Cramer, Helen; Sanders, Tom; Johnson, Rachel; Kadam, Umesh; Lasserson, Daniel; Purdy, Sarah

doi:10.1370/afm.1845

Cited by 29 publications

(53 citation statements)

References 18 publications

(16 reference statements)

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“…Additionally, all GPs felt that the term ‘heart failure’ was unhelpful in explaining the diagnosis and prognosis to patients. GPs regarded it as a ‘loaded’ term,31 having an effect on patients that was similar to being told they had cancer 2429 31 36 To avoid upsetting patients and extinguishing hope, some clinicians talked about HF in euphemistic terms, such as having an ‘ageing heart’, ‘stiff heart’ or ‘heart not pumping efficiently’ 29…”

Section: Resultsmentioning

confidence: 99%

“…29 Some GPs spoke about addressing the question of prognosis over time in response to changing circumstances, particularly where patients might be approaching the end of their life 31…”

Section: Resultsmentioning

confidence: 99%

“…25 Additionally, GPs encountered difficulties associated with comorbidities and polypharmacy, especially in elderly patients 624 26 31 36 Moreover, several GPs saw ageism as a consideration for a less aggressive approach 24–2630 34…”

Section: Resultsmentioning

confidence: 99%

“…23–26 34 Some GPs were happy to keep patients on diuretics only, possibly unaware of the potential benefits of ACE inhibitors (ACE-I) and β-blockers 23–2634 Other reasons for not prescribing ACE-I or β-blockers in patients with newly diagnosed HF were: concerns about possible side effects;6 24–26 31 worries about starting treatment in primary care as opposed to in hospital, partly because of previous teaching and a fear that patients might collapse in the community setting;6 24 26 and the burden of monitoring when titrating the medications 624 25 Even when ACE-I were initiated, GPs were cautious about using high doses 24–26…”

Section: Resultsmentioning

confidence: 99%

“…31 The timing of ACP was experienced as difficult by many GPs, because: unlike cancer, the diagnosis of HF does not start with bad news; the path of CHF is unpredictable without clear key moments; and less attention is paid to ACP in chronic diseases 623 29 31 32 35…”

Section: Resultsmentioning

confidence: 99%

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Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

et al. 2016

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ObjectivesGeneral practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs’ perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement.DesignQualitative evidence synthesis.MethodsSearches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted. The Critical Appraisal Skills Programme's checklist for qualitative research was used for quality assessment. Thematic analysis was used as method of analysis.ResultsOf 5427 articles, 18 qualitative articles were included. Findings were organised in HF-specific factors, patient factors, physician factors and contextual factors. GPs’ uncertainty in all areas of HF management was highlighted. HF management started with an uncertain diagnosis, leading to difficulties with communication, treatment and advance care planning. Lack of access to specialised care and lack of knowledge were identified as important contributors to this uncertainty. In an effort to overcome this, strategies bringing evidence into practice should be promoted. GPs expressed the need for a multidisciplinary chronic care approach for HF. However, mixed experiences were noted with regard to interprofessional collaboration.ConclusionsThe main challenges identified in this synthesis were how to deal with GPs’ uncertainty about clinical practice, how to bring evidence into practice and how to work together as a multiprofessional team. These barriers were situated predominantly on the physician and contextual level. Targets to improve GPs’ HF care were identified.

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Section: Resultsmentioning

confidence: 99%

“…29 Some GPs spoke about addressing the question of prognosis over time in response to changing circumstances, particularly where patients might be approaching the end of their life 31…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

et al. 2016

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Nurse‐led ambulatory care supported by non‐invasive haemodynamic assessment after acute heart failure decompensation

et al. 2021

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Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. Aims We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non-invasive haemodynamic assessment, on the functional status, well-being, and haemodynamic status of patients post-acute HF decompensation. Methods and results This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non-invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow-up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well-being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). Conclusions The proposed model of nurse-led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well-being, and (iii) high rate of pharmacotherapy modifications.

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Care coordination: Identifying and connecting the most appropriate care to the patients

Izumi

Barfield

Basin

et al. 2018

Research in Nursing & Health

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Although nurses are increasingly expected to fulfill the role of care coordinator, the knowledge and skills required to be an effective care coordinator are not well understood. The purpose of this study was to describe the knowledge and skills required in care coordination practice using an interpretive phenomenological approach. Fifteen care coordinators from 10 programs were interviewed over a 6-month period. Semi-structured face-to-face interviews were audio recorded, transcribed, and analyzed using interpretive phenomenology. The central theme of care coordination practice was bridging the patient and the healthcare systems. To bridge, care coordinators needed to have knowledge of the patient and healthcare system as well as the skills to identify and negotiate treatments appropriate for the patient. The most salient finding and new to this literature was that care coordinators who used their medical knowledge about available treatment options to discern and negotiate for the most appropriate care to the patient made differences in patient outcomes. Nurses with medical and healthcare system knowledge, combined with the skills to navigate and negotiate with others in an increasingly complex healthcare system, are well situated to be care coordinators and generate optimal outcomes. Further investigations of critical care coordinator competencies are needed to support nurses currently enacting the role of care coordinator and to prepare future nurses to fulfill the role.

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Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

Cited by 29 publications

References 18 publications

Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

Nurse‐led ambulatory care supported by non‐invasive haemodynamic assessment after acute heart failure decompensation

Care coordination: Identifying and connecting the most appropriate care to the patients

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