Healthcare needs and priorities of older people living with heart failure and frailty: a multi-perspective study of patients, carers and clinicians

Older people living with heart failure (HF) and frailty are a complex population growing in prevalence. Given the high level of comorbidity among these patients, a person-centered, holistic model of care is required to optimise outcomes in this cohort. However, there is limited knowledge on what matters to these patients and if current care pathways address their needs. We aimed to explore the healthcare needs and priorities of older people with HF and frailty from the perspective of patients, carers and clinicians. In a step-wise, multi-method study, we conducted a qualitative survey followed by in-depth interviews among older adults (≥ 65 years) with HF and frailty (Clinical Frailty Score ≥ 5), their informal carers (≥ 18 years) and healthcare professionals at a tertiary hospital in the UK. An inductive thematic analysis was performed on the data using the Framework Method. Between January – May 2023, 160 individuals completed the survey and 23 participated in interviews. Combined analysis of surveys and interviews revealed two major themes (i.e., healthcare needs and perceived health-related goals) and 14 subthemes. Healthcare needs identified were: (i) management of medical issues; (ii) regaining physical functioning; (iii) pharmaceutical care; (iv) nutritional care; (v) assistance with activities of daily living (ADL); (vi) environmental and social support and (vii) access to healthcare. Their health-related goals were: (i) being ADL-independent; (ii) remaining HF-symptom free; (iii); improved quality of life; (iv) being with family; (v) not a burden to family; (vi) avoiding hospitalisation and (vii) longevity. Healthcare needs of older patients living with HF and frailty are manifold; a key finding was that preserving functional capacity was given greater importance than longevity by this population. A multidisciplinary approach aligned with patients’ health priorities is essential for delivery of a meaningful goal-concordant care.