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Knowledge and communication difficulties for patients with chronic heart failure: qualitative study

BMJ 2000; 321 doi: (Published 09 September 2000) Cite this as: BMJ 2000;321:605

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Chronic Heart Failure - Authors response

Editor, We are pleased to learn that at least two research teams have
information to confirm the findings of our study of patients with chronic
heart failure. Can we assure Mair and colleagues that none of the patients
interviewed for our study were distressed or startled with our opening
question “Can you tell me how your heart failure started?” All of the
patients recruited to our study were approached while in hospital either
as an outpatient or during a hospital stay. When approached patients were
asked to take part in an interview to talk about what it was like living
with heart problems and the research interviewer established that they
knew their diagnosis at this stage. A number of patients’ chose not to
take part in the interviews because they said they had nothing wrong with
their heart and were therefore excluded. We also tentatively suggest that
as all our patients were interviewed shortly after a visit to hospital
they may have been more able to remember details of diagnosis than
patients recruited from a general practice list.

We are pleased to learn of the apparent success of nurse led heart
failure clinics in the Netherlands reported by Hak and Willems. We would
welcome some evidence to support their claim that our own findings could
be replicated in interviews with (elderly) patients with other conditions
attending any type of outpatients clinics. As we note in our paper the
optimal management of heart failure is particularly difficult requiring
the management of complex medical regimes, life style changes and careful
monitoring of signs and symptoms. This may not be the case in other
conditions for which patients, elderly, or otherwise attend hospital
outpatient clinics. As with most patients, those interviewed for our study
will have gained information about their condition from a number of
sources. While acknowledging the huge potential of nurse-led heart
failure clinics we would suggest that such clinics are not the norm in the
UK at present. As such our own findings mirror the experience of the
majority of heart failure patients in the UK at this time

Competing interests: No competing interests

21 September 2000
A E Rogers
Research Associate
A McCoy
Department of Palliative Care and Policy GKT Medical School and