Treatment Inertia Among Elderly Patients with Chronic Heart Failure: A Qualitative Study

Mengfan Jiao,1,2,* Wei Wang,1,* Chunxu Chen,1 Xiaoman Zhang,1 Xiaojing Zhao1 1Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, People’s Republic of China; 2Department of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, 271099, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaojing Zhao, Email [email protected]: Treatment inertia in chronic heart failure (CHF) commonly refers to the failure to initiate or intensify evidence-based therapy in a timely manner and refers to delays, avoidance, or inadequate engagement by patients in evidence-based therapy. While the clinician or healthcare system level have been extensively studied, patient-level inertia among elderly adults remain under-investigated due to limited health literacy patient-related factors, particularly in China where healthcare access, insurance policies, and literacy levels differ significantly. Understanding the behavioral and contextual determinants of this phenomenon is crucial for improving disease management among aging populations.Purpose: Guided by the COM-B (capability–opportunity–motivation–behavior) framework, this qualitative study explored patient-level treatment inertia and its influencing factors among elderly Chinese patients with CHF, aiming to inform culturally tailored interventions.Methods: A descriptive phenomenological design was adopted. Semi-structured interviews were conducted with 14 hospitalized CHF patients aged ≥ 60 years from May to July 2024 in a tertiary hospital in Shandong Province. Data were analyzed using Colaizzi’s seven-step method, following COREQ criteria for qualitative research reporting.Results: Three themes emerged: (1) deficient capability (insufficient symptom perception and low health literacy); (2) weakened motivation (multiple pressures, distrust in medical technology, limited engagement incentives); (3) constrained opportunity (insufficient family support and limited medical resources).Conclusion: Patient-level treatment inertia among elderly CHF patients arises from the interaction of cognitive, motivational, and systemic constraints. Enhancing health literacy, improving psychosocial motivation, and establishing family and community-based support systems may mitigate inertia and improve patient outcomes.Keywords: heart failure, treatment inertia, influencing factors, COM-B model, qualitative research