Healthcare needs in elderly patients with chronic heart failure in view of a personalized blended collaborative care intervention: a cross sectional study

Introduction Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the present study were to: (1) identify perceived healthcare needs/preferences in elderly patients with HF prior to a CM intervention; (2) investigate possible associations between healthcare needs/preferences, sociodemographic variables (age; sex) and number of comorbidities. Method Patients aged 65 years or more affected by HF with at least 2 medical comorbidities were enrolled in the study. They were assessed by structured interviewing with colored cue cards that represented six main topics including education, individual tailoring of treatment, monitoring, support, coordination, and communication, related to healthcare needs and preferences. Results Thirty-three patients (Italy = 21, Denmark = 7, Germany = 5; mean age = 75.2 ± 7.7 years; males 63.6%) were enrolled from June 2021 to February 2022. Major identified needs included: HF information (education), patients' involvement in treatment-related management (individual tailoring of treatment), regular checks of HF symptoms (monitoring), general practitioner update by a CM about progression of symptoms and health behaviors (coordination), and telephone contacts with the CM (communication). Regarding communication modalities with a CM, males preferred phone calls (χ2 = 6.291, p = 0.043) and mobile messaging services (χ2 = 9.647, p = 0.008), whereas females preferred in-person meetings and a patient dashboard. No differences in needs and preferences according to age and number of comorbidities were found. Discussion The findings highlight specific healthcare needs and preferences in older HF multimorbid patients, allowing a more personalized intervention delivered by CM in the framework of BCC.

[1]  S. Gostoli,et al.  Needs of multimorbid heart failure patients and their carers: a qualitative interview study and the creation of personas as a basis for a blended collaborative care intervention , 2023, Frontiers in cardiovascular medicine.

[2]  T. Friede,et al.  Integrated care for older multimorbid heart failure patients: protocol for the ESCAPE randomized trial and cohort study , 2023, ESC heart failure.

[3]  J. L. Sánchez-González,et al.  Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs , 2022, International journal of environmental research and public health.

[4]  A. Wister,et al.  Help-Seeking Behaviors Among Older Adults: A Scoping Review , 2022, Journal of applied gerontology : the official journal of the Southern Gerontological Society.

[5]  E. Lambrinou,et al.  A qualitative meta-synthesis of patients with heart failure perceived needs. , 2021, Reviews in cardiovascular medicine.

[6]  Kaleab Z. Abebe,et al.  Efficacy of Blended Collaborative Care for Patients With Heart Failure and Comorbid Depression , 2021, JAMA Internal Medicine.

[7]  J. McMurray,et al.  2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. , 2021, European heart journal.

[8]  J. Shao,et al.  Quality of Life and Associated Factors in Older Adults With Heart Failure , 2021, The journal of nursing research : JNR.

[9]  A. Husband,et al.  Polypharmacy definition and prevalence in heart failure: a systematic review , 2021, Heart Failure Reviews.

[10]  L. Lund,et al.  The Heart Failure Association Atlas: Heart Failure Epidemiology and Management Statistics 2019 , 2021, European journal of heart failure.

[11]  R. Wachter,et al.  Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial , 2020, BMC Cardiovascular Disorders.

[12]  Y. Griber,et al.  Color in the educational environment for older people: recent research review , 2020 .

[13]  J. Hanlon,et al.  Polypharmacy in Older Adults Hospitalized for Heart Failure , 2020, Circulation. Heart failure.

[14]  R. Wachter,et al.  Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study , 2020, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[15]  M. DiGiacomo,et al.  Patient preferences for heart failure education and perceptions of patient-provider communication. , 2020, Scandinavian journal of caring sciences.

[16]  C. Rafanelli,et al.  A survey on lifestyle and awareness of the use of statins in a sample of cardiopathic patients , 2020, Psychology, health & medicine.

[17]  Li Sun,et al.  Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old , 2019, Chinese medical journal.

[18]  Kaleab Z. Abebe,et al.  Blended Collaborative Care to Treat Heart Failure and Co-Morbid Depression: Rationale and Study Design of the Hopeful Heart Trial. , 2019, Psychosomatic medicine.

[19]  Thomas Thum,et al.  The continuous heart failure spectrum: moving beyond an ejection fraction classification. , 2019, European heart journal.

[20]  S. Riedel-Heller,et al.  Unmet health care needs in old age and their association with depression - results of a population-representative survey. , 2019, Journal of affective disorders.

[21]  K. Johnell,et al.  An update on the clinical consequences of polypharmacy in older adults: a narrative review , 2018, Expert opinion on drug safety.

[22]  J. Dettori,et al.  The Sin of Missing Data: Is All Forgiven by Way of Imputation? , 2018, Global spine journal.

[23]  Jongmin Lee,et al.  Unmet healthcare needs of elderly people in Korea , 2018, BMC Geriatrics.

[24]  A. Coats,et al.  Physical function and exercise training in older patients with heart failure , 2017, Nature Reviews Cardiology.

[25]  F. Lapi,et al.  The Burden of Chronic Heart Failure in Primary Care in Italy , 2017, High Blood Pressure & Cardiovascular Prevention.

[26]  R. Stelmach,et al.  Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study , 2016, npj Primary Care Respiratory Medicine.

[27]  L. Michalis,et al.  Association between Characteristics of Hospitalized Heart Failure Patients with Their Needs , 2015, Global journal of health science.

[28]  J. Parissis,et al.  Acute Heart Failure Syndromes in the Elderly: The European Perspective. , 2015, Heart failure clinics.

[29]  S. Majumdar,et al.  Contextualizing the Effectiveness of a Collaborative Care Model for Primary Care Patients with Diabetes and Depression (Teamcare): A Qualitative Assessment Using RE-AIM. , 2015, Canadian journal of diabetes.

[30]  S. Chaudhry,et al.  Burden of Comorbidities and Functional and Cognitive Impairments in Elderly Patients at the Initial Diagnosis of Heart Failure and Their Impact on Total Mortality: The Cardiovascular Health Study. , 2015, JACC. Heart failure.

[31]  A. LaCroix,et al.  Patterns of technology use among older adults with and without disabilities. , 2015, The Gerontologist.

[32]  Hao-Hsien Lee,et al.  [A comparison of convenience sampling and purposive sampling]. , 2014, Hu li za zhi The journal of nursing.

[33]  F. Mair,et al.  Patient, Carer and Professional Perspectives on Barriers and Facilitators to Quality Care in Advanced Heart Failure , 2014, PloS one.

[34]  B. Rollman,et al.  Treating anxiety in the presence of medical comorbidity: calmly moving forward. , 2013, Psychosomatic medicine.

[35]  T. McDonagh,et al.  Heart Failure Epidemiology: European Perspective , 2013, Current cardiology reviews.

[36]  F. Wright,et al.  How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management. , 2011, Surgical oncology.

[37]  R. Griffo,et al.  [Assessing patients needs in outpatients with advanced heart failure]. , 2011, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[38]  F. Mair,et al.  Understanding Patients’ Experiences of Treatment Burden in Chronic Heart Failure Using Normalization Process Theory , 2011, The Annals of Family Medicine.

[39]  F. Giorgino,et al.  Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo) , 2010, Vascular health and risk management.

[40]  S. Spoto,et al.  Chronic heart failure , 2001, Oxford Handbook of Cardiac Nursing.

[41]  B. White,et al.  Card sort: an assessment tool for the educational needs of patients with heart failure. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[42]  Brian T. Austin,et al.  Organizing care for patients with chronic illness. , 1996, The Milbank quarterly.