To Understand Heart Failure, Walk a Mile in the Patient's Shoes

How patients experience heart failure is often worlds apart from the way health care providers understand it.

Avoiding hospital readmissions related to heart failure has become a team-based goal among health care providers.

Clinical researchers have been able to identify evidenced-based interventions that keep heart failure patients as healthy is possible, but what is less known is what patients and caregivers identify as contributors to readmission.

The Journal of Cardiac Failure has published a study comparing 3 perspectives on heart failure readmission: those of hospitalized heart failure patients, their caregivers, and their health care providers.

The study’s intent was to identify better care strategies during post-hospital transition.

The study used an anthropological technique called freelisting, which involves asking participants to read a question and list items in response.

For example, the researchers asked the 58 patients involved in the study, “What words describe things you do to manage your heart failure at home?” and then asked similar questions to the 32 caregivers and 67 clinicians.

Questions covered home heart failure management tasks, challenges, and perceived reasons for hospital admission.

Patients and clinicians described similar home heart failure management tasks: taking medicine, eating a healthy diet, watching sodium, and checking weight.

Caregivers were more likely to list tasks related to activities of daily living, but they didn’t identify checking weight and watching sodium.

The researchers indicated that this discordance means clinicians need to spend more time with caregivers and emphasize health maintenance tasks.

Clinicians cited socioeconomic factors such as financial constraints, lack of caregiver and social support, poor access to care and medications, lack of knowledge about heart failure, and poor health literacy as challenges to heart failure management.

Patients and caregivers had different views. They indicated that limited functional status, daily activities, reduced independence, and stress were the biggest barriers.

Patients who had no caregiver indicated that access to medication was a big challenge.

Patients and caregivers attributed the need for hospitalization to distressing symptoms and illness. Clinicians blamed patient behaviors such as nonadherence and poor diet for readmission.

This means patients and caregivers may not be making the connection between health maintenance tasks (adherence, weight management, or diet) and hospitalization, the researchers noted.

Health care providers will need to find ways to better appreciate heart failure patients’ challenges and educate their caregivers, as well.

With 5.1 million Americans afflicted with heart failure, the disease’s cost could double by 2030 unless new ways are developed to alleviate its overall impact.