Personalising renal function monitoring and interventions in people living with heart failure: protocol for co-designing a care pathway in the RENAL-HF programme.

Background: Heart failure affects almost one million people in the UK and is increasing in prevalence. Many drugs used to treat heart failure impair renal function and can lead to hospitalisation. Adverse drug problems can be partially mitigated through regular renal monitoring and optimising of drug dose and choice to prevent deterioration of kidney function. This protocol describes part of a wider research programme: personalising renal function monitoring and interventions in people living with heart failure (RENAL-HF).

Aim: The aim of RENAL-HF is to develop improved processes in primary care to manage kidney health in people living with heart failure.

Method: The protocol covers gathering views of healthcare professionals, patients and carers, to co-develop a care pathway for use in primary care. Using a mixed methods approach, the work comprises six stages: 1) understanding current practice of optimising heart failure treatment while preserving renal function, 2) co-designing a care pathway including personalised renal function monitoring, thresholds for intervention and clinical guidelines, 3) decision-making to identify elements that will support the care pathway, 4) developing training materials for primary care to enable use of the care pathway, 5) testing the useability of the prototype care pathway, and 6) a feasibility and acceptability study to inform the pre-clinical development and usability of the care pathway ahead of a cluster randomised control trial.

Conclusion: All stages will elicit evidence from primary care practices, practitioners, and patients with which to assess and refine the care pathway. The evidence will inform how algorithm-guided individualised treatment can be implemented to improve outcomes of patients with heart failure.