Scientific Summary

Heart failure (HF) accounts for 2% of NHS expenditure, and 5% of emergency hospitalisations. Patients with HF with preserved ejection fraction (HFpEF) are older, have more comorbidities, have similarly poor or worse outcomes compared to patients with reduced ejection fraction (HFrEF), and currently lack an evidence base for treatment.

Hypothesis and Aims:  We hypothesise that outcomes of patients with heart failure with preserved ejection fraction (HFpEF) can be improved through an optimised management programme which would be based in primary care, in collaboration with specialist services.  To develop this programme our study will seek better understanding of the needs and experiences of patients with HFpEF, their management in primary care and important outcomes.  We will integrate findings from research with the expertise of clinicians and patients to develop the programme of optimised management.  Our objectives are to:

  1. Systematically review the literature on management and self-management models of care for patients with HFpEF and co-morbidities.
  2. Determine patient and primary and specialist health care provider preferences and perspectives on burden of illness and treatment, care needed and organisation of services/support to meet needs and be acceptable to patients and providers.
  3. Identify patients with HFpEF in primary care and assess comorbidities, lifestyle factors, frailty, self-management, symptoms, quality of life, cognitive function, types of care received, management of risk factors and comorbidities, and one year morbidity and mortality.
  4. Develop an optimised programme of management for HFpEF that addresses comorbidities, self-management including lifestyle factors, the burden of treatment, and transitions in care.

Methods: Mixed methods including Work Package 1 (WP1) a systematic review ; WP2a qualitative research involving patients and HCPs; WP2b a cohort study of 200 patients with HFpEF in primary care followed for 12 months; WP3 consensus methods (nominal groups of patients and HCPs) to develop an optimised management programme and test components for feasibility and acceptability.  The House of Care, systems thinking and the concepts of burden of treatment and minimally disruptive medicine will provide theoretical frameworks for the optimised programme.  The finalised programme will be piloted and trialled in a subsequent study.