Optimizing support before and after Cardiac Resynchronization Therapy implantation in co-creation with patients with heart failure, informal caregivers and healthcare professionals

Aims. To optimize support by healthcare professionals to enhance physical activity, HF-related symptom monitoring, and management in patients with heart failure before and after cardiac resynchronization therapy (CRT) implantation in co-creation with patients, informal caregivers, and healthcare professionals. Methods and results. A qualitative and co-design approach was used to develop support strategies collaboratively with end-users. Seventeen semi-structured interviews were conducted to explore patients’ expectations and factors influencing physical activity and symptom management. The qualitatively obtained insights informed the development of support strategies using an ideas group with patients, informal caregivers, and healthcare professionals. Four themes emerged from the interviews: (1) expecting and hoping to regain energy and fitness; (2) difficulties and opportunities to become more active; (3) impact of CRT on sense of safety; and (4) dealing with continuing bothersome symptoms. Several strategies were brainstormed, prioritized, and prototyped, including optimization of CRT information, a peer contact list, expansion of the post-CRT implantation consultation to ask questions and share concerns, and a group meeting with peer patients, partners, and healthcare professionals. Conclusion. Patients expected and hoped to have positive effects from CRT, but not all patients experienced improvement after CRT. To improve patients’ physical activity, feelings of insecurity, symptom monitoring, and thoughtful response to symptoms, support must include providing information and support to increase their knowledge and discuss experiences and physical and mental concerns.