Barriers and facilitators to use of the HEARTRISK6 Scale for acute heart failure presentations in the emergency department: a qualitative study.

Objective: Acute heart failure is the second most common reason for return visits to the emergency department (ED) in Canada. Half of all acute heart failure patients presenting to the ED can be discharged, suggesting admission is not always necessary. The HEARTRISK6 Scale was recently developed from prospectively collected data of 2,246 acute heart failure patients from 10 Canadian EDs. This tool comprises six routine ED criteria and aids disposition decisions by estimating the risk of poor outcomes. Currently, it is not known what ED clinicians think of the tool. This study aimed to determine the factors impacting emergency physician use of the HEARTRISK6 Scale, and to identify the relevant opportunities to increase uptake of the tool.

Methods: We conducted semi-structured interviews with ED attending and resident physicians at The Ottawa Hospital and nearby community sites. An interview guide based on the theoretical domains framework (TDF) was used to capture factors within the 14 domains that may influence the use of HEARTRISK6. Interview transcripts were coded using direct content analysis, and belief statements were generated to capture similar responses. Relevant and non-relevant domains were identified based on their frequencies, presence of conflicting ideas, and perceived influence.

Results: Sixteen interviews (thirteen attendings, three residents) were conducted with ED physicians. Eleven of the fourteen TDF domains were identified as relevant. Participants described key facilitators to be teaching about the tool, positive colleague views, increased objectivity of disposition decision, ease of access, and feeling it benefited their work. Desire for more evidence, competing demands, and need for consultant buy-in were noted as important barriers.

Conclusion: This study identified key barriers and facilitators to use of HEARTRISK6 Scale for acute heart failure patients. These factors provide targets for developing interventions aimed at encouraging routine use of HEARTRISK6 among ED physicians in clinical practice.