Clinicians’ and patients’ experiences of managing heart failure during the COVID-19 pandemic: a qualitative study

Why it matters

The COVID-19 pandemic resulted in unprecedented disruption and change in the provision of healthcare in the UK. Some studies reported that heart failure services were disproportionately affected.

Patients with heart failure have an increased risk of poor outcomes and a significant risk of severe illness and death connected to COVID-19 infection, or rapid deterioration due to cancellation of services and changes to routine monitoring and prescribing. However, older adults with heart failure were not included on the list of vulnerable patients identified by NHS England as being at high risk of complications from COVID-19.

This research explored patients’ and providers’ experiences of managing established heart failure during the pandemic, including changes in care practices and the consequences of these changes.

Approach

Our research focused on three regions in England: Cambridgeshire, Greater Manchester and the West Midlands. Thirty semi-structured interviews were held with older adults with established heart failure and the primary and secondary healthcare providers involved in their care.

What we found

Compliance with the government guidance to ‘stay at home, protect the NHS and save lives’ during the pandemic and perceptions of risk led to significant behavioural and organisational changes.

Concern about contracting COVID-19 when older and living with heart failure was universally acknowledged in the interviews and this risk heavily influenced behavioural responses. In contrast to earlier studies describing unhealthy lifestyle behaviours, in the present study we observed that many patients with heart failure made or experienced positive health-protective changes.

While none of the patients interviewed described a deterioration in their heart failure status during the pandemic, some did reflect on balancing the risk of virus exposure against the risk of deterioration from underlying conditions. Balancing these competing risks was frequently at the forefront of decision-making for many clinicians managing patients whose conditions were deteriorating.

Both patients and clinicians spoke of the challenge of gauging clinical risk and there was significant uncertainty, particularly in the absence of specific shielding guidance for people with heart failure.

Patients described attempting to mitigate the risk of contracting COVID-19 by ‘being careful’ or ‘sensible’ and using support networks to limit their exposure. Both patients and clinicians reported increased efforts to self-monitor, as they tried to avoid needing to physically attend healthcare settings. The convenience and efficiency of telephone consultations were noted. However, the appropriateness of non-face-to-face consultations was considered situation-dependent and there was concern over the ‘digital divide’.

Some changes, such as enhanced relationships and self-monitoring, are opportunities, and there should be consideration of how to maintain or develop these. Others, such as disengagement and withdrawal, and the fallout from reluctance to access health services, should be acknowledged and interventions developed to address these challenges.