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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR48

A qualitative assessment of health-related issues of importance in congestive heart failure patients

By Sumanthra Varma, James C. McElnay and Carmel M. Hughes

Introduction In recent years, considerable attention has focused on the pathophysiology, drug therapy and risk factors associated with congestive heart failure (CHF) in the elderly. However, little research has been undertaken on the attitudes and beliefs of elderly patients with CHF and therefore there is limited knowledge about health-related issues important to this population.
Qualitative research methodology provides an ideal opportunity to investigate these issues. "Too often we fail to perceive how the patient feels about having their condition and its effect upon their relationships with others".1 Therefore, using a qualitative research approach (focus group discussions), the aim of this study was to assess factors which impact on the health-related quality of life of CHF patients.

Method Six general medical (GP) practices which were willing to participate in the study identified potential subjects from their records. Inclusion criteria were: over the age of 65 years; had a confirmed primary diagnosis of CHF; were orientated to self, time and place; and did not have any concurrent chronic condition, the symptoms of which could be confused with CHF (eg, chronic obstructive airways disease).
The focus groups were held at the respective GP practices and the broad subject areas addressed were: patients' knowledge of their condition; medication; lifestyle; relationships; locus of control; and general issues on care of the elderly. All discussions were audio-taped, transcribed and entered into the QSR NUDIST computer package, which generated the main themes from the discussions.

Focal points

  • There has been little research on the attitudes and beliefs of elderly patients with CHF
  • Using a qualitative research approach (focus group discussions), the study sought to assess factors which impact on the health-related quality of life of CHF patients
  • Patients lacked knowledge on CHF and its management and reported that their condition impacted on their lifestyle and emotions
  • Some patients felt that they had little control over their condition
  • Education through counselling and written information may be of benefit to CHF patients

Results Twenty-nine elderly CHF patients (16 male and 13 female) participated in the focus group discussions. Knowledge about their condition varied widely, with eight participants reporting no knowledge about CHF and 11 having reasonable knowledge.
The majority of patients felt that their medication was of benefit to them; in most cases, the participants were only able to identify their medication as being used in the treatment of their heart condition and few were able to describe how the medication controlled their symptoms.
A number of participants stated that CHF had dramatically affected their lifestyle as they suffered from breathlessness and fatigue; two patients reported that their lifestyle had been unchanged by their condition. A range of emotions was evoked in patients, varying from sadness, annoyance, and irritation to a feeling of gratitude regarding how well their condition was controlled.
Commonly, participants reported that family members were overly protective of them, while one patient stated that he tended to get irritable with his family.
Patients with more severe heart failure felt that their doctor was in control of their heart failure, while other participants considered that their doctor shared the management of their condition with them.
All participants felt very satisfied with the treatment they were receiving, although a number did feel that it would be beneficial to receive counselling on some aspects of CHF. However, patients did comment that additional information on CHF may force individuals to be more restrictive in their activities and not all patients would be capable of dealing with further information on their heart condition.

Discussion The focus groups generated valuable information on aspects of CHF which were of importance to patients. Most participants demonstrated a poor knowledge about CHF and its drug treatment; a basic knowledge of this chronic medical condition and its management would assist patients in adapting to a new way of life.2 Its impact on lifestyle was illustrated by participants reporting breathlessness and fatigue; again, education on the value of exercise would have long-term symptomatic benefits.3 Those patients who felt that they were not in control of their heart failure may also benefit from further education on CHF.
It would appear that many patients would appreciate and benefit from further information on CHF either through counselling or written information.

Pharmacy practice research group, school of pharmacy, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland

References

1. Partridge MR. Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education? Eur Resp J 1995; 55:9A-15A.
2. Dracup K, Baker D, Dunbar S et al. Management of heart failure II. Counselling, education and lifestyle modification. J Am Ger Soc 1994;272:1442-6.
3. Dargie HJ, McMurray J. Diagnosis and management of heart failure. BMJ 1994; 308:321-8.