Barriers and enablers of self-care in women with heart failure with preserved ejection fraction: a systematic review

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Aims: This systematic review examines factors that inhibit or promote effective self-care in women with heart failure with preserved ejection fraction. Methods: The review followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Search strategies were based on previous heart failure reviews and consultations with patients, clinical experts and an information specialist. Databases searched included MEDLINE, EMBASE, EMCARE, CINAHL, APA PsycINFO and COCHRANE (July 2024). Searches combined strings for women, heart failure with preserved ejection fraction and self-care. Studies were grouped by female representation: ≤40% and >40%, 40% being the typical female representation in cardiovascular clinical trials. Two reviewers independently conducted study selection and data coding. Results were organised into themes: emotions, environmental, decision-making and social identity. Results: Of 406 studies identified, 126 were reviewed and 13 met the inclusion critera, involving a total of 1277 women. In studies with greater than >40% female representation, emotional, environmental, decision-making and social identity factors had a stronger influence on self-care compared to studies with less than <40% representation. Emotional barriers included fear, anxiety and depression, while support, trust and connection were enablers. Environmental barriers included financial constraints and programmes designed for male-dominated heart failure with reduced ejection fraction populations. Facilitators included group physical activities held in medical fitness centres and home-based programmes. Decision-making was hindered by family obligations and delayed healthcare-seeking, but strong self-regulation improved self-care. Social roles often led women to prioritise caregiving over their own health, and physical activity assessment tools frequently lacked relevance for their needs. Conclusions: Across studies – especially those with higher female representation – women with heart failure with preserved ejection fraction faced emotional (fear, anxiety, depression), financial and caregiving barriers that delayed care; enablers included trust, support, group activities, home programmes and self-regulation, while many activity tools lacked relevance. These factors were under-reported in studies with fewer women, underscoring sex/gender disparities. Tailored support and greater female inclusion in research are essential to improve self-care.

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