Patient and clinician perspectives on digital tools in heart failure: results in three London hospital networks (Qual-HF).

Aims: There are limited data on the experience and perspectives of patients or clinicians about the use of digital tools (DTs, such as internet resources, social media, and smartphone apps) in heart failure (HF). This study aimed to explore patient and clinician perspectives of DT use and provide insights into the factors that facilitate or obstruct such use. Methods and results: This was a mixed-methods study using semi-structured interviews with 14 people living with HF and 9 clinicians working as HF specialists. Recorded interviews underwent thematic analysis. Three main themes emerged: 'the dual nature of information', the 'recommendation gap', and 'self-care as a time-dependent behaviour'. Patients were generally fearful of information from DTs, with many disengaging from their use as a form of self-preservation. Patients described finding the 'right' information as a struggle, and their behaviour appeared related to their level of digital health literacy and degree of activation. Recommendation of DTs by clinicians was influenced by assumptions around the digital the capability of patients, the lack of evidence-based guideline recommendations, and a lack of local or international consensus around the use of DTs. Conclusion: Many patients living with HF are anxious about online information and withdraw from using DTs. A clinician's recommendation may help, providing an 'information prescription', but is limited by assumptions about patients and lack of training, local consensus, and clear international guidance. Routine assessment of digital capability, particularly in older patients, may balance some of these assumptions and support more consistent and equitable use.