Common health problems management uncertainties in heart failure: a qualitative study.

Background: Medicine review with follow up quantitative studies conducted on heart failure (HF) outpatients detected health problems that were frequently treated insufficiently: hyperuricemia, gastric injury prevention, anemia, and diabetes mellitus.

Objective: The aim of this qualitative study was to explore experiences in the pharmacological management of these health problems, and to contribute with strategies to overcome the identified obstacles.

Methods: The internal medicine specialists and cardiologists of a tertiary hospital HF clinic underwent in-depth semi-structured interviews and a constant comparative approach was used.

Results: Interviewees highlighted there is a lack of guidelines concerning the treatment of asymptomatic hyperuricemia in HF, thus in routine practice it is often not treated. Interviewees said that preventive strategies to avoid gastric injury in at-risk patients taking prophylactic low-dose aspirin are needed, but the most appropriate strategy is not well defined. Interviewees thought that structural support is needed for the management of HF patients with anemia, and proper clinic pathways should be created to identify which service patients should be referred to. The same lack of communication with other services appeared with diabetes mellitus.

Conclusion: HF specialists demand a closer interaction with other specialists for a comprehensive approach to these polymedicated patients with multiple co-morbidities. And suggest that specific recommendations in HF guidelines to manage these co-morbidities specifically in HF would be helpful to shed light upon the existing confusing evidence.