Exploring elderly multimorbid heart failure patients' health-related quality of life within a blended collaborative care framework: understanding the role of care managers

Introduction: Health-Related Quality of Life (HRQoL) is considered a primary outcome in person-centered treatments for heart failure (HF) multimorbid elderly patients. Understanding the factors influencing HRQoL and the role of care managers (CMs) in personalized care is essential. Aims: Study 1: explore sociodemographic, clinical, psychological and psychosocial characteristics on HRQoL among elderly multimorbid HF patients; Study 2: explore CMs’ perspectives on their role within a Blended Collaborative Care (BCC). Methods: Study 1 analyzed data from HF patients (65+ years, ≥2 comorbidities, psychological distress) in the ESCAPE BCC trial (Horizon 2020, Grant 945377). Data included sociodemographics, medical history, and standardized psychological assessments. Study 2 collected qualitative data through semi-structured interviews with CMs (Italy: N=4; Denmark: N=2), analyzed using thematic coding. Results: Study 1 included 33 patients (mean age: 77.6 ± 6.8 years; 52% male). NYHA class was negatively associated with better disease-specific QoL. Higher perceived health status was linked to ≤5 years of cardiac disease duration, while more comorbidities and pacemakers correlated with poorer perceived health. Disease-specific QoL was associated with communication tools and anxiety. All QoL types were linked to physical capability. Perceived health differed by frailty, illness perception, and depression, while frailty and depression affected all QoL types. Global QoL varied by physical function and cognitive impairment, and psychological distress was associated only with disease-specific QoL. Study 2 found that CMs view their role as essential in elderly HF care, emphasizing trust-building and proactive support. However, BCC and the CM role require adaptation to clinical practice. Conclusions: The research provided a better understanding of HRQoL determinants in older multimorbid HF patients. In addition to clinical characteristics, factors such as communication tools, physical and cognitive status, frailty, illness perception, and psychological distress should be recognized in patients’ care. BCC is suggested to be better adapted to clinical practice.