--- title: "Determinants of Patient Delay in Seeking Care for Worsening Heart Failure: Systematic Review Proto" id: "bmj-open-17-determinants-of-patient-delay-in-seeking-care-for-worsening-heart-failure" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-17-determinants-of-patient-delay-in-seeking-care-for-worsening-heart-failure" content_type: "clinical_feed_article" specialty: "Cardiology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e115816?rss=1" published_at: "2026-09-21T12:57:17.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Determinants of Patient Delay in Seeking Care for Worsening Heart Failure: Systematic Review Proto ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-17-determinants-of-patient-delay-in-seeking-care-for-worsening-heart-failure - **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e115816?rss=1) - **Published At:** 2026-09-21T12:57:17.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - The protocol addresses delays by adults (≥18 years) in seeking care after onset or awareness of **worsening heart failure** symptoms occurring outside hospital settings. - Delays are common and linked to rehospitalisation, premature death, poorer quality of life and higher healthcare costs; longer delays associate with more severe clinical status and worse outcomes. - Existing quantitative and qualitative studies report mixed and fragmented findings due to variable candidate predictors, populations and settings. - This review is the first HF-specific, theory-driven synthesis using **Andersen’s Behavioural Model of Health Services Use**, grouping determinants as predisposing, enabling and need factors. - Eligible studies are observational analytical designs (cohort, case–control, analytical cross-sectional) reporting quantitative measures of **patient delay** (time from symptom awareness/onset to decision to seek care or first healthcare contact). - Databases to be searched from inception to 25 November 2025: PubMed, EMBASE, Web of Science Core Collection, CINAHL, Cochrane Library, CNKI, WanFang Data and SinoMed. - Inclusion limited to full-text articles in English or Chinese; screening and data extraction will be performed in duplicate. - Risk of bias assessment: Newcastle–Ottawa Scale for cohort and case–control studies; JBI critical appraisal tool for analytical cross-sectional studies. - Where appropriate, random-effects meta-analyses will pool effect estimates for the same determinant and delay definition; prespecified subgroup and sensitivity analyses will explore heterogeneity. - Certainty of evidence for key determinant–delay relationships will be graded using the GRADE approach; if meta-analysis is not feasible, a structured narrative synthesis will be provided. - Ethical approval is not required because the review uses published, anonymised data. Results will be disseminated via peer-reviewed journals, conferences and knowledge translation activities. - PROSPERO registration number reported: CRD420251242808. ## Clinical Analysis & Structured Key Points Introduction Worsening heart failure (HF) is common and associated with rehospitalisation, premature death, poor quality of life and high healthcare costs. Patients frequently delay seeking medical care for hours or days after symptom escalation, and longer delays are linked to more severe clinical status at presentation and worse outcomes. Existing quantitative and qualitative studies have explored multiple potential determinants of patient delay, but findings remain fragmented and inconsistent, partly due to differing sets of candidate predictors and variation in populations and healthcare settings. To date, no HF-specific, theory-driven systematic review has synthesised determinants of patient delay for worsening HF within Andersen's Behavioural Model of Health Services Use or quantified their associations with delay. Methods and analysis This protocol describes a systematic review and meta-analysis that will synthesise determinants of patient delay in seeking care for worsening HF symptoms arising in out-of-hospital settings among adults (≥18 years). We will include observational analytical studies (cohort, case - control and analytical cross-sectional designs) that report quantitative measures of patient delay, defined as the time from first awareness or onset of worsening HF symptoms to the decision to seek care or first contact with a healthcare facility. Based on Andersen's model, candidate determinants will be grouped as predisposing, enabling and need factors. We will search PubMed, EMBASE, Web of Science Core Collection, CINAHL, Cochrane Library, CNKI, WanFang Data and SinoMed from inception to 25 November 2025, include full-text articles in English or Chinese and perform duplicate screening and data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Scale for cohort and case - control studies and the JBI critical appraisal tool for analytical cross-sectional studies and where appropriate we will conduct random-effects meta-analyses to pool effect estimates for the same determinant and delay definition with prespecified subgroup and sensitivity analyses to explore heterogeneity. The certainty of evidence for key determinant-delay relationships will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach, and where meta-analysis is not feasible, we will provide structured narrative synthesis. Ethics and dissemination As this study involves secondary analysis of published, anonymised data, formal ethical approval and informed consent are not required. Findings will be disseminated through peer-reviewed journals, academic conferences and knowledge translation to inform clinical practice and patient education. 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