Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

Sarah Charman, Nduka Okwose, Gregory Maniatopoulos, Sara Graziadio, Tamara Metzler, Helen Banks, Luke Vale, Guy A MacGowan, Petar M Seferović, Ahmet Fuat, Christi Deaton, Jonathan Mant, Richard F D Hobbs, Djordje G Jakovljevic

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OBJECTIVE: To explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.

DESIGN: Qualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.

SETTING: Newcastle upon Tyne, UK.

PARTICIPANTS: Fourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).

RESULTS: Four themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.

CONCLUSION: The development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

Original languageEnglish
Article numbere028122
Number of pages7
JournalBMJ Open
Issue number4
Publication statusPublished - 14 Apr 2019
Externally publishedYes

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.


  • Adult
  • Attitude of Health Personnel
  • Cardiac Output/physiology
  • Exercise Test/methods
  • Female
  • Focus Groups
  • Heart Failure/diagnosis
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Practice Patterns, Physicians'
  • Primary Health Care/methods
  • Qualitative Research


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