Forsyth, F, Blakeman, T, Burt, J, Chew-Graham, CA, Hossain, M, Mant, J, Sharpley, J, Sowden, E and Deaton, C (2022) Cumulative Complexity: A qualitative analysis of patients’ experiences of living with heart failure with preserved ejection fraction. European Journal of Cardiovascular Nursing. ISSN 1474-5151

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<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>To investigate how Heart Failure with preserved Ejection Fraction, within the context of limited clinical services, impacts upon patients’ lives.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods &amp; Results</jats:title> <jats:p>Secondary thematic analysis informed by the Cumulative Complexity Model (CCM), of interview transcripts from 77 people diagnosed with HFpEF and their carers. Four themes corresponding to the core concepts of workload, capacity, access and outcome described in the CCM were generated. Theme 1: Shouldering a Heavy Workload, described the many tasks expected of people living with HFpEF. Theme 2: The Multiple Threats to Capacity described how patients and carers strived to engage with this work, but were often faced with multiple threats such as symptoms and mobility limitations. Deficient Illness Identity (Theme 3) reflects how HFpEF either was not recognised or was perceived as a more benign form of HF and therefore afforded less importance or priority. These themes contributed to a range of negative physical, social and psychological outcomes and the perception of loss of control described in Theme 4: Spiraling Complexity.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The constellation of HFpEF, multimorbidity and aging creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. Patients' recollections of their interactions with health professionals suggest there is widespread misunderstanding of HFpEF, which can prohibit access to care that could potentially reduce or prevent deterioration.</jats:p> </jats:sec>

Item Type: Article
Additional Information: © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 22 Sep 2022 11:58
Last Modified: 22 Sep 2022 11:58

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