University affiliation
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care
Main supervisor
Katharina Schmidt-Mende, MD PhD, associate professor in general practice, GP
PhD project participating in the National Research School in General Medicine.
Current treatment guidelines for heart failure are largely based on studies that exclude older, multimorbid heart failure patients. In primary care, this group predominates, and knowledge gaps remain regarding the benefit of pharmacological treatment. The aim of this PhD project is to describe real-world older heart failure patients in primary care to provide better support for clinical decision-making in everyday practice.
Heart failure is a global public health problem and a major contributor to both morbidity and mortality. Its prevalence increases steeply with age and is often associated with substantial multimorbidity. In Sweden, diagnostic evaluation and pharmacological treatment follow the guidelines of the European Society of Cardiology (ESC). However, it remains unclear how older patients are investigated and treated in practice, particularly regarding the balance between risks and benefits. A better understanding of current diagnostic and therapeutic practices may help assess the applicability of existing guidelines and support clinicians in their decision-making for older patients with heart failure.
Aim
The doctoral project aims to improve understanding of the diagnostic process and pharmacological management of older heart failure patients in primary care.
Methods
The project consists of four sub-studies:
Study 1 is a quantitative, descriptive cross-sectional study including all patients with heart failure in the Stockholm Region in 2022. By linking administrative registry data, including the National Patient Register (specialist care) and the VAL databases (primary care), the study compares patients managed exclusively in primary care with those also seen by a cardiologist.
Study 2 is a qualitative study using focus group interviews with general practitioners in the Stockholm Region to explore their experiences of diagnosing and treating older patients with heart failure.
Study 3 will be a medical record review aimed at assessing the degree of adherence to recommended pharmacological therapy among patients managed in primary care.
Study 4 will be a scoping review summarizing the current evidence on the effectiveness and safety of pharmacological treatment in older heart failure patients.
Relevance
As primary care assumes increasing responsibility for the management of heart failure, particularly among the oldest and most frail patients, it is essential to have up-to-date, practice-oriented evidence on how diagnostic and treatment guidelines are applied in real-world settings.
University affiliation
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care
Main supervisor
Katharina Schmidt-Mende, MD PhD, associate professor in general practice, GP