Heat management insights from heart failure clinicians and patients

Rising temperatures increase morbidity in heart failure. Despite the recognised importance of self-management in heart failure care, current heat-health management practices (e.g., guidance on adjusting fluid balance, exercise, and cooling during hot weather) among individuals living with heart failure and clinicians remain poorly understood. Therefore, we explored the lived experiences of individuals with heart failure and the perspectives of healthcare professionals managing heart failure patients in a warming climate. A qualitative descriptive approach was used, employing two focus group discussions. Groups consisted of individuals living with heart failure (n=8, and their partners n=2), who were diagnosed with chronic heart disease/heart failure and receiving specialist care, and healthcare professionals (n=11), including cardiologists, general practitioners, nurses, physiotherapists, exercise physiologists, dietitians, and pharmacists, with >10 years of experience in heart failure management. Discussions, facilitated by semi-structured interview guides, explored participants' experiences with heat-health management, including topics of hydration, exercise, and personal cooling strategies. Audio recordings were transcribed verbatim and analysed using a thematic framework approach. Four main themes emerged. Central to these was the importance of individualized management in heart failure. The other three themes highlighted the complexity of managing HF in the context of heat, the varied experiences of heat education among individuals living with heart failure and clinicians, and the absence of specific guidance, leading to generalized advice and patients seeking independent solutions. Analysis highlighted discrepancies between clinician intentions and experiences of individuals living with heart failure regarding heat-health management. While clinicians described providing individualised advice on fluid management, exercise modification, and cooling strategies, individuals living with heart failure consistently reported receiving generic or delayed guidance. Both groups identified substantial knowledge gaps regarding medication-heat interactions and exercise safety in hot conditions. Clinicians relied on "common-sense" approaches rather than evidence-based protocols, while individuals living with heart failure found accessing information about managing their condition during heat exposure challenging. Our data show a disconnect between clinician intentions and the experiences of individuals living with heart failure in managing heart failure during heat exposure. There is a pressing need for evidence-based, individualised heat-health strategies and improved communication tools. Bridging this gap is essential to support safe and effective self-management in a warming climate.