Elsevier

Heart & Lung

Volume 37, Issue 4, July–August 2008, Pages 257-265
Heart & Lung

Issues in cardiovascular nursing
“They diagnosed bad heart”: A qualitative exploration of patients' knowledge about and experiences with heart failure

https://doi.org/10.1016/j.hrtlng.2007.09.001Get rights and content

Background

Patient education is central to the management of individuals with heart failure; therefore, it is important to know what these patients understand and experience both clinically and personally.

Objectives

This study qualitatively explored patients' knowledge regarding a heart failure diagnosis, their understanding of their cardiac care providers' treatment recommendations, and their views concerning the impact of heart failure on their daily lives and prognosis.

Methods

A qualitative study was conducted whereby data were collected through 25 telephone interviews with adults being followed for heart failure at a Veterans Affairs medical center. Subjects were interviewed using semistructured open-ended questions. Audiotaped responses were analyzed using grounded theory methods.

Results

The majority of participants were elderly, male, and white, and had New York Heart Association class II disease. Participants without angina typically experienced a lengthy and difficult diagnostic delay, with symptoms misattributed to comorbid diseases. Most understood the importance of self-monitoring and adhering to physician recommendations, and their discussions of life-changing effects typically focused on loss of physical functioning and decreased quality of life. Although participants wanted to know their prognosis, most had not received information about it or about advance care planning.

Conclusion

Patients require opportunities for enhanced communication with physicians and health care team members during the challenging diagnostic period and subsequently need more information about their medical condition and prognosis.

Section snippets

Participants and procedures

Patients were eligible for our study if they were 18 years or older, were able to speak and read English, had a B-type natriuretic peptide level of 100 or higher,15 and were receiving treatment from a primary care provider or cardiologist at an outpatient clinic of the Veterans Affairs (VA) Pittsburgh Healthcare System.

Ninety patients were enrolled in the quantitative portion of our study. Of the 90 patients, 25 were randomly selected to participate in the qualitative portion of the study. For

Characteristics of participants

Of the 25 participants, most were elderly (mean age 70.4 years; range 53–87 years), male (96%), white (92%), married (60%), and retired (68%), and had at least a high school diploma (76%) (Table I). On a scale ranging from excellent to poor, most rated their current health as either fair (40%) or poor (44%). Most had NYHA class II disease (52%), characterized by slight or mild limitation of activity; class II patients are comfortable at rest or with mild exertion. The B-type natriuretic peptide

Discussion

Our findings suggest that the process of diagnosing heart failure, particularly for patients without initial angina, is challenging and frustrating. Once the diagnosis is made, most patients understood that it is important to actively participate in their care by self-monitoring, adhering to a treatment plan, and undergoing continued testing. The findings of this study suggest that patients do not think they have received adequate information from their health care providers. For example, they

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    Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

    Financial Support: This work was supported in part by the following awards to Dr. Rodriguez: a Merit Review Entry Program Award from the Veterans Affairs (VA) Health Services Research and Development Office (MRP 04-410), a Minority Supplement Award from the National Cancer Institute (3R01 CA100387-03S1), and a grant from the Pilot Project Program of the Center for Health Equity Research and Promotion (LIP 981) and VA Stars and Stripes Healthcare Network 4 (VISN4).

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