Gaps in care delivery for patients with heart failure: A qualitative study of patients with multiple readmissions

BACKGROUND: Despite significant advances in the management of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF), readmission rates remain high. OBJECTIVES: In this study, we sought to understand the experiences and gaps in care delivery among heart failure (HF) patients with multiple readmissions. METHODS: We conducted a qualitative study using semistructured interviews with patients admitted with HF exacerbation and who had a prior admission for HF exacerbation within 1 year of the interview. We analyzed the interview contents using thematic analysis. Additionally, we reviewed the medical charts and collected information regarding patients' disease course and treatments. RESULTS: Our study included 24 patients, 54% had HFrEF, and 46% had HFpEF. Two major themes emerged; the first theme was centered on hospital readmissions, which often uncovered gaps in communication and deficiencies in discharge education. Patients expressed frustration with recurrent admissions, identified communication challenges while inpatient, and highlighted the shortcomings of the current discharge education models. The second theme explored the ways in which fragmented understanding of HF as a result of gaps in effective care delivery impacted multiple domains of care spanning the spectrum from initial diagnosis to prognosis. The interviews highlighted important differences between patients with HFrEF and HFpEF. CONCLUSIONS: Patients with HF and recurrent admissions shared multiple gaps in care delivery with important differences noted between HFpEF and HFrEF patients. These findings can inform the design of future targeted interventions to ensure effective care delivery to a high-risk population.