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

Faye Forsyth,Carolyn A Chew-Graham,Fd Richard Hobbs,Aaron Long,Thomas Blakeman,Duncan Edwards,Clare J Taylor,Christi Deaton,Muhammad Zakir Hossain,Emma Sowden,Jonathan Mant

doi:10.3399/bjgpopen19x101675

Abstract

BackgroundHeart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty.AimThe primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme.Design & settingThis is a multi-method programme of research conducted in the UK.MethodOPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group.ResultsResults from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward.ConclusionHFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF.

Highlights

Heart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF) and is associated with greater diagnostic difficulty and management uncertainty.[1]
Results from the four work packages will be synthesised to produce a summary of key learning points and possible solutions which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward
HFpEF is often described as the greatest unmet need in cardiology

Summary

Introduction

HFpEF is less well understood than HFrEF and is associated with greater diagnostic difficulty and management uncertainty.[1]. Understanding of underlying pathophysiological processes continues to develop through research, and varying models have been proposed to explain the abnormal cardiac structure and function observed.[2,4,8] The current preferred paradigm is that microvascular endothelial inflammation, driven by coexisting conditions, leads to myocardial inflammation and fibrosis that in turn results in increased oxidative stress and alterations in cardiomyocyte signalling.[2,8] Diagnostically, while definitions and criteria have been tightened, universal consensus and a definitive algorithm are lacking.[9,10,11] In treatment terms, evidence-b ased pharmacological therapies and device options are limited and developments lag behind those observed in HFrEF.[4] Disease management programmes consistently demonstrating reduced mortality and re-h ospitalisation rates in HF do not frequently include or explicitly analyse data on HFpEF;[12,13] benefits observed cannot confidently be extrapolated. A persistent gap between best and current practice exists, which is compounded by a lack of integrated care.[14,15,16]

Methods

Discussion

Conclusion