Intended for healthcare professionals

Rapid response to:

General Practice

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

Rapid Response:

Chronic heart failure -- findings point to failing health care organisation

Editor - At present we are conducting a prospective qualitative study
in which we interview 40 patients with severe heart failure about their
quality of life. Many of our respondents tell us the same things as
reported by Rogers et al. in their paper on knowledge and communication
difficulties for patients with chronic heart failure. They also tend to
attribute symptoms of heart failure to advancing age, do not know much
about their condition, and are unable to ask their doctors further
questions about their illness and its management.

However, these findings
apply mainly to a specific subgroup in our sample, namely those patients
who attend a traditional outpatient cardiology clinic in which treatment
consists mainly of the disposal of medication and a three-monthly 10-
minute consultation, often with a different doctor each time. However,
they do not apply to the subgroup of patients who attend a nurse-led heart
failure clinic, which they visit once or twice a month for a 30-minute
consultation and in which their personal circumstances are discussed
extensively. These patients learn how to recognise and manage symptoms,
how to monitor their weight, how to adjust their diet, etc., all on an
individual basis. Because these patients already know a lot about their
condition and how to manage it, they generally do not raise the issues
described by Rogers et al.

It is therefore fair to say that the findings
of the paper by Rogers et al. do not apply specifically to chronic heart
failure - the same findings would probably be found in interviews with
(elderly) patients with other conditions attending the same kind of
outpatient clinic. In conclusion, the findings reported by Rogers et al.
describe the effects of a specific way of organising health care.

Competing interests: No competing interests

14 September 2000
Tony Hak
medical sociologist, general practitioner
Dick Willems
Institute for Research in Extramural Medicine (EMGO),Van der Boechorststraat 7,1081 BT Amsterdam,NL