The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicentre randomized controlled trial

Dalal, H. M. et al. (2019) The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicentre randomized controlled trial. European Journal of Preventive Cardiology, 26(3), pp. 262-272. (doi: 10.1177/2047487318806358) (PMID:30304644) (PMCID:PMC6376602)

Abstract

Background: Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low. Design and methods: The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone. Results: The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of –5.7 points (95% confidence interval –10.6 to –0.7) in favour of the REACH-HF intervention group (p = 0.025). With the exception of patient self-care (p < 0.001) there was no significant difference in other secondary outcomes, including clinical events (p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant. Conclusions: The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Dalal, H. M., Taylor, R. S., Jolly, K., Davis, R. C., Doherty, P., Miles, J., van Lingen, R., Warren, F. C., Green, C., Wingham, J., Greaves, C., Sadler, S., Hillsdon, M., Abraham, C., Britten, N., Frost, J., Singh, S., Hayward, C., Eyre, V., Paul, K., Lang, C. C., and Smith, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: European Journal of Preventive Cardiology
• Publisher: SAGE
• ISSN: 2047-4873
• ISSN (Online): 2047-4881
• Published Online: 10 October 2018
• Copyright Holders: Copyright © 2018 The European Society of Cardiology
• First Published: First published in European Journal of Preventive Cardiology 26(3):262-272
• Publisher Policy: Reproduced under a Creative Commons License