From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study
ObjectivesTo explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.DesignQualitative interview study.SettingParticipants were recruited from a secondary care clinic in central England following referral from primary care.Partic...
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| Veröffentlicht in: | BMJ open 2017-03, Vol.7 (3), p.e013648-e013648 |
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| creator | Taylor, C J Hobbs, F D R Marshall, T Leyva-Leon, F Gale, N |
| description | ObjectivesTo explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.DesignQualitative interview study.SettingParticipants were recruited from a secondary care clinic in central England following referral from primary care.ParticipantsOver age 55 years with a recent ( |
| doi_str_mv | 10.1136/bmjopen-2016-013648 |
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Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.ResultsParticipants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term ‘heart failure’ was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.ConclusionsGreater public awareness of symptoms and adequate explanation of ‘heart failure’ as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2016-013648</identifier><identifier>PMID: 28283487</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Activities of Daily Living ; Adaptation, Psychological ; Age ; Age groups ; Aged ; Aged, 80 and over ; Anxiety - etiology ; Awareness ; Cardiovascular Medicine ; Chronic illnesses ; Chronic obstructive pulmonary disease ; Codes ; Dyspnea - diagnosis ; Dyspnea - etiology ; Dyspnea - psychology ; England ; Female ; Health Knowledge, Attitudes, Practice ; Heart attacks ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - psychology ; Humans ; Interviews ; Male ; Medical diagnosis ; Methods ; Middle Aged ; Patient Acceptance of Health Care ; Patients ; Primary care ; Primary Health Care ; Qualitative Research ; Referral and Consultation ; Secondary Care ; Surveys and Questionnaires</subject><ispartof>BMJ open, 2017-03, Vol.7 (3), p.e013648-e013648</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2017 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b4158-f1c996c245d1d42f0472f1121348240af465a3f5af13be6cc5565452755bee5e3</citedby><cites>FETCH-LOGICAL-b4158-f1c996c245d1d42f0472f1121348240af465a3f5af13be6cc5565452755bee5e3</cites><orcidid>0000-0001-8926-2581</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmjopen.bmj.com/content/7/3/e013648.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmjopen.bmj.com/content/7/3/e013648.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27526,27527,27901,27902,53766,53768,77344,77375</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28283487$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taylor, C J</creatorcontrib><creatorcontrib>Hobbs, F D R</creatorcontrib><creatorcontrib>Marshall, T</creatorcontrib><creatorcontrib>Leyva-Leon, F</creatorcontrib><creatorcontrib>Gale, N</creatorcontrib><title>From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesTo explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.DesignQualitative interview study.SettingParticipants were recruited from a secondary care clinic in central England following referral from primary care.ParticipantsOver age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care.MethodsSemistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.ResultsParticipants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term ‘heart failure’ was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.ConclusionsGreater public awareness of symptoms and adequate explanation of ‘heart failure’ as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.</description><subject>Activities of Daily Living</subject><subject>Adaptation, Psychological</subject><subject>Age</subject><subject>Age groups</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anxiety - etiology</subject><subject>Awareness</subject><subject>Cardiovascular Medicine</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Codes</subject><subject>Dyspnea - diagnosis</subject><subject>Dyspnea - etiology</subject><subject>Dyspnea - psychology</subject><subject>England</subject><subject>Female</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - psychology</subject><subject>Humans</subject><subject>Interviews</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Patient Acceptance of Health Care</subject><subject>Patients</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Qualitative Research</subject><subject>Referral and Consultation</subject><subject>Secondary Care</subject><subject>Surveys and Questionnaires</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkc1q3DAUhUVoScI0T1Aogm66cap_210USmjSQqCbdC1k-3pGgy05kpwwuz5En7BPEpmZhLSLEm0kdL9zOJeD0FtKzinl6mMzbv0ErmCEqoLkH1EdoVNGhCgUkfLVs_cJOotxS_IRspaSHaMTVrGKi6o8RfNl8CNuApi0GSBGnDzujR3mAJ9w3I1TymPvIiRsXIc7a9bOx2RbPIJx1q2xdXgyyYJLEd_btMEbMCE9mvz59dvg29kMNmXoDnBMc7d7g173ZohwdrhX6Ofl15uLb8X1j6vvF1-ui0ZQWRU9betatUzIjnaC9USUrKeU0ZydCWJ6oaThvTQ95Q2otpVSSSFZKWUDIIGv0Oe97zQ3I3RtDhnMoKdgRxN22hur_544u9Frf6cll5zTKht8OBgEfztDTHq0sYVhMA78HDWtSiXqcom0Qu__Qbd-Di6vp5lSvOaVYtX_qMWLcCHqheJ7qg0-xgD9U2RK9NK_PvSvl_71vv-sevd82yfNY9sZON8DWf0ixwctJ74B</recordid><startdate>20170310</startdate><enddate>20170310</enddate><creator>Taylor, C J</creator><creator>Hobbs, F D R</creator><creator>Marshall, T</creator><creator>Leyva-Leon, F</creator><creator>Gale, N</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8926-2581</orcidid></search><sort><creationdate>20170310</creationdate><title>From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study</title><author>Taylor, C J ; Hobbs, F D R ; Marshall, T ; Leyva-Leon, F ; Gale, N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b4158-f1c996c245d1d42f0472f1121348240af465a3f5af13be6cc5565452755bee5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Activities of Daily Living</topic><topic>Adaptation, Psychological</topic><topic>Age</topic><topic>Age groups</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anxiety - etiology</topic><topic>Awareness</topic><topic>Cardiovascular Medicine</topic><topic>Chronic illnesses</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Codes</topic><topic>Dyspnea - diagnosis</topic><topic>Dyspnea - etiology</topic><topic>Dyspnea - psychology</topic><topic>England</topic><topic>Female</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - psychology</topic><topic>Humans</topic><topic>Interviews</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Patient Acceptance of Health Care</topic><topic>Patients</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Qualitative Research</topic><topic>Referral and Consultation</topic><topic>Secondary Care</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taylor, C J</creatorcontrib><creatorcontrib>Hobbs, F D R</creatorcontrib><creatorcontrib>Marshall, T</creatorcontrib><creatorcontrib>Leyva-Leon, F</creatorcontrib><creatorcontrib>Gale, N</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taylor, C J</au><au>Hobbs, F D R</au><au>Marshall, T</au><au>Leyva-Leon, F</au><au>Gale, N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2017-03-10</date><risdate>2017</risdate><volume>7</volume><issue>3</issue><spage>e013648</spage><epage>e013648</epage><pages>e013648-e013648</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesTo explore 2 key points in the heart failure diagnostic pathway—symptom onset and diagnostic meaning—from the patient perspective.DesignQualitative interview study.SettingParticipants were recruited from a secondary care clinic in central England following referral from primary care.ParticipantsOver age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care.MethodsSemistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.ResultsParticipants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term ‘heart failure’ was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.ConclusionsGreater public awareness of symptoms and adequate explanation of ‘heart failure’ as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28283487</pmid><doi>10.1136/bmjopen-2016-013648</doi><orcidid>https://orcid.org/0000-0001-8926-2581</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Activities of Daily Living Adaptation, Psychological Age Age groups Aged Aged, 80 and over Anxiety - etiology Awareness Cardiovascular Medicine Chronic illnesses Chronic obstructive pulmonary disease Codes Dyspnea - diagnosis Dyspnea - etiology Dyspnea - psychology England Female Health Knowledge, Attitudes, Practice Heart attacks Heart failure Heart Failure - diagnosis Heart Failure - psychology Humans Interviews Male Medical diagnosis Methods Middle Aged Patient Acceptance of Health Care Patients Primary care Primary Health Care Qualitative Research Referral and Consultation Secondary Care Surveys and Questionnaires |
| title | From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure—a qualitative study |
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