Current Challenges and Future Innovation in Rural Heart Failure Care: A Qualitative Analysis

BACKGROUND: Individuals living with heart failure experience challenges managing frequent hospital admissions and life-altering symptoms, including dyspnea, fatigue, and depression. These challenges are exacerbated by the unique obstacles associated with receiving healthcare in a rural community. Their care partners often do not receive sufficient support to care for someone with heart failure and experience fatigue, social isolation, and anxiety. OBJECTIVE: Explore the insights of individuals involved in and/or receiving heart failure care at a rural academic medical center with the aim of identifying what is working well, opportunities for improvement, and actionable recommendations to improve heart failure care delivery. METHODS: Twenty-two semistructured qualitative interviews were conducted with patients, care partners, healthcare clinicians, support staff, and operational leaders affiliated with a rural academic medical center. A qualitative analysis process was used to compare content regarding six key domains: experience with heart failure, challenges to optimal healthcare delivery and/or quality of life, optimal current healthcare services, ideal theoretical health and community services, palliative care, and involvement with care partners. RESULTS: Interviewees reported challenges related to symptom and care partner burden, fragmented healthcare communication, limited institutional support, and an unclear role for palliative care. Interviewees suggested that integrating personalized care strategies, improving communication and coordination, and expanding specialized support may help address these challenges. CONCLUSIONS: Patients living with heart failure in a rural setting experience unique challenges inherent to their disease and the community in which they receive their care. Interviewees proposed addressing these challenges through multidisciplinary, systems-level changes to reframe the approach to managing heart failure for patients and their care partners.