What services are currently provided to people with Heart Failure with preserved Ejection Fraction in the UK and what are their components? A systematic scoping review.

Abstract

Aim: To review the clinical services currently provided to people with heart failure with preserved ejection fraction (HFpEF) living in the United Kingdom (UK). To examine the format of clinical care and to assess these against UK guideline recommendations provided by the National Institute for Health and Care Excellence (NICE).

Methods & results: A systematic scoping review was performed. We synthesised articles narratively according to the Systematic Review without Meta-analysis (SWiM) guidelines, drawing on other established recommendations for narrative methods. We critically appraised articles using Critical Appraisal Skills Programme tools. Following screening (n=11,495) and full-text review (n=68), we included 25 unique reports from databases and nine operations documents received following a public appeal. Overall reporting within both published articles and operations documents was sub-optimal, limiting our description of service provision. From the data available, it appeared that most services were NICE guideline compliant for overall heart failure management, however multiple services augmented clinical teams with additional specialists to assist in the management of people with HFpEF. Thematic analysis suggested variability in HFpEF services, uncertainty over the optimal clinic format and management strategies, which was complicated by complexity in patients. Cumulatively, publications suggested there is a need for service re-design.

Conclusion: HFpEF care in the UK appears variable and the format of optimal services to improve outcomes is not yet clear. Patient complexity makes management challenging. Although some clinical services have made efforts to adapt to HFpEF patients' needs, there remain significant gaps in service provision and care. Findings underscore a pressing need for service re-design.

Registration: This scoping review protocol was published on the public Open Science Framework platform (no registration reference provided) and can be accessed at: https://osf.io/5gufq/.