Towards a novel multidimensional nursing intervention addressing frailty in people with heart failure: a modified Delphi study

Introduction

Frailty in people with heart failure (HF) is associated with poor outcomes. Multidimensional interventions addressing frailty in people with HF are recommended to improve outcomes.  Nurses are frequently involved in delivering frailty interventions. Related contributions are rarely described in detail. As part of the development of a novel evidence-informed complex nursing intervention, this study aimed to assess the relevance and feasibility of components addressing frailty in people with HF from the perspective of potential end users. 

Methods

We used the RAND/UCLA Appropriateness Method. First, we developed a rating form including 27 intervention components. Second, five healthcare professionals caring for people with HF and one person living with HF rated the relevance and clarity of the components. They were also invited to suggest additional components. Then, 14 Swiss nurse panellists recognised as experts in caring for people with HF in geriatric and cardiology settings rated each component on a 9-point scale for its relevance regarding health outcomes and for feasibility regarding the delivery of the components as part of usual care, and re-rated them after a hybrid panel discussion. For both relevance and feasibility, components with a median of 7-9 were classified as relevant/feasible, >3-<7 as uncertain, and 1-3 as not relevant/not feasible; Components with disagreement were classified as uncertain.

Results

Panellists rated all 27 components as relevant. They rated 21 components as feasible, and six as uncertain. These concerned aerobic and endurance training, resistance training, balance and coordination training, digital health technologies, medication dose adjustment, and cognitive stimulation activities. Feasibility concerns were linked to resource constraints, scope of practice, digital health technology, and interprofessional collaboration. 

Conclusions

Uncertainty regarding the feasibility of relevant components highlighted implementation conditions that should be addressed during intervention development to maximise future implementation of a multidimensional nursing intervention for frailty in people with HF.