Patient experiences of cardiac diagnostic assessment in primary care: a qualitative study of pathways, delays and communication in people with heart failure suggestive symptoms

Patients presenting to primary care with symptoms suggestive of heart failure (HF), such as breathlessness and ankle swelling, frequently experience uncertainty before a diagnosis is made. Delays are common and most patients are diagnosed only after hospitalisation.(1-2) These symptoms overlap with other long-term conditions, increasing the risk of misattribution and fragmented assessment.(3-5) Understanding patient experiences of early cardiac diagnostic pathways is essential to inform safer, timelier identification of HF and related cardiac conditions.

To explore patient experiences of cardiac diagnostic assessment, communication and follow-up in primary care among individuals presenting with HF-suggestive symptoms, and to identify factors influencing diagnostic delay and uncertainty.

A qualitative process evaluation was conducted within a primary-care feasibility study. Semi-structured interviews were undertaken with 25 patients recruited from six general practices in socioeconomically diverse areas. Following informed consent, interviews explored access to care, diagnostic assessment, investigations, explanations and follow-up. Data were professionally transcribed and analysed using reflexive inductive thematic analysis (Braun and Clarke approach).(6)

Nine men and sixteen women participated (median age, 62 years ([IQR 51-69], over one-third living in the most deprived neighbourhoods). Participants described complex and often prolonged diagnostic journeys, regardless of eventual diagnosis. Symptoms were frequently misattributed to anxiety, ageing or respiratory conditions, and multiple consultations commonly preceded cardiac investigation. Few participants were aware of any structured diagnostic assessment or decision-support being used. Access barriers (e.g. early-morning telephone queues and digital triage systems), poor continuity of care and reactive follow-up contributed to diagnostic delay and uncertainty. Communication gaps around test results and next steps were common, leading many patients to self-chase appointments or seek information independently. In contrast, continuity with a trusted clinician and nurse-led services supported clearer diagnostic progression and reassurance.

Patients presenting with HF-suggestive symptoms experience substantial diagnostic uncertainty and fragmentation in primary care, even when they do not go on to receive an HF diagnosis. Improving access, continuity and communication, alongside structured diagnostic support, may reduce missed opportunities for timely identification of cardiac disease. Nursing roles are central to strengthening diagnostic pathways and improving patient experience.