ESC Florence Nightingale Lecture in Nurse-Led Research: Prof. Christi Deaton
27 Aug 2021
Presenter of the 2021 ESC Florence Nightingale Lecture in Nurse-Led Research, Christi Deaton, Professor of Nursing at the University of Cambridge and Cambridge University Hospitals, UK, is passionate about developing effective systems and clinical practice to optimise the management of patients with heart failure with preserved ejection fraction (HFpEF).
What got you interested in cardiology?
What first drew me to cardiology in the 1970s were the patients, the experiences they were having, and how much there was to learn. What has kept me fascinated are the extraordinary changes in treatment I have witnessed throughout my time in the specialty. When I started clinical practice, there were no real treatments for people who had had a myocardial infarction. The introduction of thrombolysis in the 1980s changed the picture for these patients. I was fortunate to work in a centre involved in the Thrombolysis in Myocardial Infarction (TIMI) trials and to see the results unfold. Our understanding of heart failure (especially with reduced ejection fraction) has also evolved – I can remember when beta blockers were contraindicated in their treatment – but there is still much to be done, especially in HFpEF.
Tell us something about your lecture topic
My lecture presents the work we have been doing – a programme of qualitative and quantitative research in HFpEF – and the importance of taking a multidisciplinary approach. We believed that there was a great deal that could be done to improve the management of patients with HFpEF, but we first needed to understand what was happening in practice and the challenges to providing effective care.
We have assessed and followed a cohort of individuals with HFpEF recruited from primary care practices, and have over 140 interviews with patients, their carers, and clinicians across the different sectors of the healthcare system, exploring their experiences and problems and soliciting their opinions on possible solutions. Our focus is not only how to find more effective treatments, but also how we can be more effective in delivering the treatments we have to our patients. And this relies on improving the patient management systems we have in place and collaboration across healthcare.
What do you see as current and future challenges?
HFpEF is a heterogeneous syndrome and there are still issues around ensuring that diagnosis is performed consistently and accurately. In addition, part of the problem with its management is that there is still a lack of understanding about this multimorbidity condition – to really improve management, it is important to see the total picture, not just the heart failure.
We know that patients benefit from physical activity and that self-management is important, but we also need to learn how to support patients better to achieve these. There’s a really important role for nurses to play in bridging the gap that we see far too often between specialist services and primary care. And finding better ways of communicating will help patients to move seamlessly across the different sectors of healthcare.
Where do you think research is heading in the future?
Our research has shown not only the value of a multidisciplinary approach to the management of patients with HFpEF, but the value of multidisciplinary perspectives in research. We need to ensure that more nurses and allied health professionals are involved in and leading programmes of research for the different perspectives and questions that they bring. Our research team is multidisciplinary and spans both primary care and specialist services, and that has been a benefit. I think research in the future has to determine not only what treatments are effective (pharmacological and non-pharmacological), but how to deliver treatments and services effectively and efficiently, and in ways most beneficial to patients. Including patients’ and carers’ voices in research is essential.
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