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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

Rapid Response:

Chronic Heart Failure - Levels of Knowledge Deficit May Be Even Greater

Editor – We were pleased to read the paper by Rogers et al. regarding
knowledge and communication difficulties for patients with chronic heart
failure. As the authors point out chronic heart failure is an increasing
public health problem. Yet, to date, despite the abundance of literature
regarding patient management there is a relative paucity of research that
examines this illness from the patients’ perspective. Chronic heart
failure is a label with potentially alarming connotations for the patient.
We were therefore, interested to see that when dealing with such a
sensitive issue the first question mentioned by the interviewers in this
project was, “Can you tell me how your heart failure started?” This
clearly assumes patients knew their diagnosis. Were not many individuals
startled or distressed by this question?

We, in Liverpool, have recently completed a qualitative project based
in primary care, exploring patients’ perceptions of this illness (1).
One of our key findings was that, not only do patients lack knowledge
regarding prognosis, in fact most patients are actually unaware of their
diagnosis. We performed interviews with fifty primary care patients who
had a definite diagnosis of heart failure, based on echocardiographic
findings, and were on treatment with both diuretics and Angiotensin
Converting Enzyme inhibitors. We found that only ten of the fifty
participants (20%) were aware they had a diagnosis of “heart failure.”
In addition, three of these individuals only learned of their diagnostic
label because they had overheard health care providers speaking about
their diagnosis rather than through informed discussions. We had
anticipated patients might lack this basic knowledge about their illness
and had been particularly careful about how we conducted our interviews

The most obvious difference between our patient populations is
recruitment source: primary care vs. secondary care. However, 78% (39/50)
of our patients had been in hospital for an admission relating to their
heart condition suggesting that the patient populations shared similar
background experiences.

If the knowledge base of our patient groups is so substantially
different, this clearly raises important questions and has major
implications for: health care providers attempting to address
communication issues; and those trying to develop educational
packages/interventions for this patient population.

1. Ling MS, Mair FS, Lloyd-Williams F. Chronic Heart Failure (CHF)
In Primary Care: How Does It Affect Quality Of Life And What Does It Mean
To The Patient? Proceedings of the North American Primary Care Research
Group (NAPCRG), San Diego, USA November 1999.

Competing interests: No competing interests

12 September 2000
Frances S Mair
Senior Lecturer (Clinical), Research Associate, Lecturer
Ffion Lloyd-Williams, M Ling
Department of Primary Care, University of Liverpool, Whelan Bldg, Quadrange, Brownlow Hill, L69 3GB