'Keeping the plates spinning': a qualitative study of the complexity, barriers, and facilitators to caregiving in heart failure with preserved ejection fraction

Examining Heart Failure Informal Care Partners Using Person and System Levels and Domains: A Meta-Synthesis

BACKGROUND

Within the last decade, system and policy-level changes have driven substantial shifts in heart failure (HF) care from hospital to home, requiring greater support from informal care partners. What has not been examined is the state of the care partner science by person and system-level domains using qualitative studies to understand impact across multiple person and system levels.

OBJECTIVES

(1) Identify by person and system levels and domain what is known about informal care partners and (2) Identify gaps in the caregiving science and suggest ways to move forward.

METHODS

This secondary analysis of a large HF systematic review is guided by the National Institute on Minority Health and Health Disparities and MIRACLE frameworks and uses meta-synthesis techniques with critical realist approaches to synthesize and interpret the themes across papers.

RESULTS

Using data from 46 papers and 1695 care partners, we identified patterns occurring across 6 domains (biological, behavioral, affective, physical/built environment, sociocultural environment, and healthcare system) and on 4 levels (individual, interpersonal, community, and societal). Existing research predominantly addressed affective and behavioral domains, followed by health system and sociocultural domains. Few studies focused on biological and physical/built environment domains, leaving large gaps in what is known about caregiving at the cellular (biological) and societal (community and societal) levels.

CONCLUSIONS

HF caregiving continues to be studied at a very rudimentary level. This synthesis also reveals critical gaps in what is known about caregiving within the physical/built environment domain and at the community and societal levels.

Understanding the Lived Experience of Patients With Heart Failure During the COVID-19 Pandemic: A Systematic Review and Meta-synthesis of Qualitative Studies

BACKGROUND

Patients with heart failure face multifaceted challenges, including emotional, social, and psychological burdens, while managing their condition. The COVID-19 pandemic exacerbated these difficulties, amplifying fear, uncertainty, and healthcare complexities, further complicating their experiences.

OBJECTIVE

The objective of this study was to identify and analyze the challenges faced by patients with heart failure during the pandemic.

METHODS

A systematic review and meta-synthesis were conducted to analyze data from qualitative studies. Data were sourced from EMBASE, PubMed, and SCOPUS, spanning from March 11, 2020, when the WHO declared COVID-19 a pandemic, to May 5, 2023, marking the end of COVID-19 as a global public health emergency.

RESULTS

A systematic review and meta-synthesis were conducted, identifying 676 articles through database searches: CINAHL-Complete (n = 130), PubMed (n = 313), SCOPUS (n = 210), hand search (n = 22), and Thai journal online (ThaiJO) (n = 1). After screening and quality assessment using the Critical Appraisal Skills Programme, 17 full-text articles of sufficient quality involving 277 participants with heart failure from East Asia (Taiwan, Japan), Southeast Asia (Thailand, Indonesia), Europe (Denmark, UK, Spain, Italy, Sweden), North America (United States), and the Middle East (Iran) were included in the synthesis. Six primary themes emerged: (1) Emotional Impact-patients reported increased anxiety, fear of disease progression, and heightened feelings of isolation, (2) Limited Physical and Social Activities-restrictions during the pandemic significantly disrupted daily routines, (3) Cultivating Resilience and Meaningful Living-many adapted by finding new coping mechanisms and purpose, (4) Divergent Perspectives on Care Delivery Innovation-although telehealth offered convenience for some, others faced challenges because of the lack of in-person care, (5) Social Support from Family and Friends-family support was critical but often limited by quarantine measures, and (6) Trust in Healthcare Providers-trust emerged as a key factor in managing heart failure during the crisis. Using the GRADE-CERQual approach, the certainty of evidence was evaluated and ranged from moderate to high.

CONCLUSIONS

The findings underscore the urgent need for targeted interventions that address the emotional and practical needs of patients with heart failure during crises. By promoting well-being and enhancing healthcare delivery, these insights can inform healthcare providers and policymakers in developing tailored support strategies aimed at improving patient outcomes and quality of lifePROSPERO registration number: CRD42024526561.

What services are currently provided to people with heart failure with preserved ejection fraction in the UK, and what are their components? A protocol for a scoping literature review

AIMS

Heart failure (HF) with preserved ejection fraction (HFpEF) is increasing in incidence and is increasingly the most common HF diagnosis. Patients with HFpEF are often excluded from specialist HF services, which has negative impacts on their healthcare experiences and health-related outcomes. As emerging evidence-based treatments are being incorporated into clinical guidelines, it is timely to focus on the management of this phenotype. This review aims to explore literature around care provision for HFpEF in the UK, to characterize and assess HFpEF care pathways against current standards, and to generate evidence to create an optimized framework of care.

METHODS AND RESULTS

A scoping review of the evidence from six databases will be performed, alongside a search of grey literature search and consultation with relevant experts. Given the expected heterogeneity, multiple lines of synthesis are anticipated. Data analysis will follow best practice guidelines for the synthesizing methodologies selected. Patient and public representatives will assist with analysis and in identifying priority components for HFpEF clinical services.

CONCLUSION

This scoping literature review will enable an in-depth examination of the current health service provision for those with HFpEF in the UK. Synthesis of key components of services and illumination of challenges and barriers will inform current and future practice. There is a long history of specialist HF care in the UK, including seminal work on nurse-led care. Therefore, evidence derived from this review will likely be useful to HF services across Europe. The proposed combination of the search across both peer-reviewed literature and grey literature, combined with patient and public involvement, will identify the key components of a framework of care for those with HFpEF.

REGISTRATION

This scoping review protocol was published on the public Open Science Framework platform (no registration reference provided) and can be accessed at: https://osf.io/5gufq/.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review

BACKGROUND

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy.

OBJECTIVE

The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science?

METHODS

This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness.

RESULTS

Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities.

CONCLUSIONS

Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.