The clinical pathway of patients with heart failure in primary care

Taylor, Clare Joanne (2016). The clinical pathway of patients with heart failure in primary care. University of Birmingham. Ph.D.

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Background: Heart failure is a common clinical syndrome associated with major adverse symptoms and poor outlook for patients, and high costs for healthcare systems globally. This thesis examines four aspects of the clinical pathway of patients with heart failure in primary care.

Methods: Routinely collected GP records are used to estimate the number of newly diagnosed heart failure cases by year. A qualitative interview study explores the patient experience of the diagnostic pathway. Survival analysis is used to determine prognosis of patients following a first diagnostic label. Finally, a screening study examines who develops heart failure over time.

Results: The incidence of heart failure has been static at 2.3 cases per 1,000 person-years since 2006. Patients initially normalise their symptoms so delay seeking help, GP access is challenging and communication in secondary care, particularly delivery of diagnosis, could be improved. Survival rates are 81.5%, 51.6% and 29.5% at 1, 5 and 10 years, respectively, and have not changed over time. Screening provides an alternative pathway to identify patients with heart failure.

Conclusions: Strategies to reduce the number of new cases of heart failure, enhance patient experience, improve survival and explore new diagnostic pathways should be important priorities for the NHS.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: School of Health and Population Sciences, Primary Care Clinical Sciences
Funders: National Institute for Health Research
Subjects: R Medicine > RC Internal medicine


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