Understanding Roadblocks to Heart Failure Care (UNLOCK-HF): A Convergent Parallel Mixed-Methods Study in Kerala

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Heart failure (HF) presents a significant global health challenge, with rising prevalence in low- and middle-income countries.
• Suboptimal uptake of guideline-recommended care contributes to high morbidity, mortality, and healthcare costs associated with HF.
• Kerala, India, faces a high burden of cardiovascular disease, necessitating an understanding of HF care barriers.

Purpose of the Study:

• To investigate the specific roadblocks to optimal heart failure care delivery in Kerala, India.
• To identify challenges in the availability, affordability, and accessibility of HF treatments and diagnostics.

Main Methods:

• A convergent parallel mixed-methods study was employed.
• Data on medicine availability and pricing were collected from 30 pharmacies.
• Interviews with patients, carers, physicians, and policymakers explored barriers to HF prevention, diagnosis, and treatment.

Main Results:

• Mean availability of HF medicines was 45% in government pharmacies and 66% in private pharmacies.
• Affordability varied significantly, with private sector diagnostics and procedures being particularly costly for low-wage workers.
• Interviews highlighted care fragmentation, poor program integration, and awareness gaps as key issues.

Conclusions:

• Key roadblocks to optimal heart failure care include low medicine availability, poor affordability, and fragmented healthcare services.
• A coordinated, multilevel approach involving all health system stakeholders is crucial for improving equitable and effective HF care.