How should we care for patients with heart failure in primary care? A protocol for a mixed-methods systematic review of primary-care-based models of care for patients with heart failure

Background

An estimated 64.3 million people are living with heart failure (HF) world-wide, and with an aging population, the prevalence is rising, placing significant pressure on existing healthcare systems. Primary care is specialised in providing care to patients with complex, long-term conditions, such as HF. Specific named models of care have been studied, however, the role of primary care in relation to HF is not clearly defined. Furthermore, it is unclear which model, or its elements, correlate with improved outcomes for patients and the primary care system.

The approach

The primary aim of the review is to understand the characteristics and/or elements of each model of care which contribute to improved outcomes for patients with HF. The search combines keywords for HF, primary care and models of care in Medline, Embase, Cinahl and Cochrane. A mixed-methods approach has been chosen because of its role in understanding complex interventions, and patient-related outcome measures (PROMS), which are poorly represented in existing meta-analyses. The quality and risk-of-bias of all included studies will be assessed.

Findings

The studies identified in this review will be compared to recognised models of care, in order to understand how the different elements of each model are able to contribute to improved outcomes for patients with HF. Outcomes will focus on those critical to policy makers, patients, and clinicians, including hospital admissions, mortality, cost and resource utilisation, and PROMs. Data synthesis will follow a sequential explanatory method, analysing both quantitative and qualitative data.

Implications

Understanding models of care for patients with HF in primary care will enable development of new models, which may better meet the needs of patients and lead to more sustainable primary healthcare. The methods outlined in this protocol can be implemented to provide an inclusive and holistic review to guide clinical practice and further research.