Austin Rosalynn, Khair Eva, Blakeman Thomas, Hossain Muhammad Zakir, Sowden Emma, Chew-Graham Carolyn, Forsyth Faye, Deaton Christi
Department of Public Health, University of Stavanger, Stavanger, Norway.
Cardiology Research, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
BMJ Open. 2024 Dec 20;14(12):e092993. doi: 10.1136/bmjopen-2024-092993.
As heart failure (HF) with preserved ejection fraction (HFpEF) prevalence increases, it remains frequently underdiagnosed and poorly managed. Recent positive pharmacological trials have increased interest in HFpEF but challenges of diagnosis and management remain. The survey aim was to examine consensus between primary and secondary care providers regarding HFpEF diagnosis and management.
As part of a larger programme of work, survey questions were developed in an online format and piloted with healthcare providers (HCPs). The survey link was distributed via professional networks and social media. Analysis included frequencies of responses, comparison by main professional groups and thematic analysis free-text responses. A virtual workshop of HCPs was conducted to discuss and refine survey findings.
HCPs (n=66) across the UK participated: 19 general practitioners (GPs), 20 HF specialist nurses (HFSN), 17 cardiologists and 10 others. Consensus was high (92%) that diagnosing the type of HF was very important and most favoured inclusion of HFpEF in Quality Outcome Framework indicators. No clear consensus was reached that ongoing management should be in primary care (47.5% of GPs, 35% of HFSN and 31.3% of cardiologists 'somewhat agreed'). Opinions differed between GPs (52.3)% and specialists (HFSN 80% and cardiologists 81.3%) for practice nurses to be upskilled and assume HFpEF management. No HCPs reported any level of disagreement for HFSN management of HFpEF. Free-text comments highlighted resource barriers to HFpEF diagnosis and management and confirmed the need to develop better HFpEF services.
Consensus was reached regarding importance of diagnosing HFpEF, but agreement on methods and responsibilities for diagnosis and management varied. Free-text comments identified HCPs concerns related to overwhelmed primary and secondary care services and lack of sufficient resources to meet existing patient demands. Creation of collaborative care pathways is needed to support the increasing number of older patients with HFpEF.
ClinicalTrials. gov (reference number: NCT03617848).
随着射血分数保留的心力衰竭（HFpEF）患病率的增加，它仍然经常未被诊断出来且管理不善。最近的阳性药物试验增加了人们对HFpEF的兴趣，但诊断和管理方面的挑战依然存在。该调查的目的是检验初级和二级医疗服务提供者在HFpEF诊断和管理方面的共识。
作为一个更大工作项目的一部分，以在线形式制定了调查问卷，并在医疗服务提供者（HCPs）中进行了试点。调查链接通过专业网络和社交媒体进行分发。分析包括回答频率、按主要专业群体进行的比较以及对自由文本回答的主题分析。举办了一次HCPs虚拟研讨会，以讨论和完善调查结果。
英国各地的HCPs（n = 66）参与了调查：19名全科医生（GPs）、20名HF专科护士（HFSN）、17名心脏病专家和10名其他人员。对于诊断HF类型非常重要这一点，达成了高度共识（92%），并且大多数人赞成将HFpEF纳入质量结果框架指标。对于持续管理是否应由初级医疗服务负责，未达成明确共识（47.5%的全科医生、35%的HF专科护士和31.3%的心脏病专家“ somewhat agreed”）。对于执业护士提高技能并承担HFpEF管理工作，全科医生（52.3%）和专科医生（HF专科护士80%，心脏病专家81.3%）的意见存在差异。没有HCPs报告对HF专科护士管理HFpEF有任何程度的不同意见。自由文本评论强调了HFpEF诊断和管理的资源障碍，并确认需要开发更好的HFpEF服务。
就诊断HFpEF的重要性达成了共识，但在诊断和管理的方法及责任方面的意见存在差异。自由文本评论指出HCPs担心初级和二级医疗服务不堪重负，以及缺乏足够资源来满足现有患者需求。需要创建协作式护理路径，以支持越来越多的老年HFpEF患者。
ClinicalTrials.gov（参考编号：NCT03617848）。
