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Randomized Controlled Trial
. 2019 Feb;26(3):262-272.
doi: 10.1177/2047487318806358. Epub 2018 Oct 10.

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

Hasnain M Dalal  1   2 , Rod S Taylor  1 , Kate Jolly  3 , Russell C Davis  4 , Patrick Doherty  5 , Jackie Miles  6 , Robin van Lingen  7 , Fiona C Warren  1 , Colin Green  1 , Jennifer Wingham  1 , Colin Greaves  8 , Susannah Sadler  1 , Melvyn Hillsdon  9 , Charles Abraham  10 , Nicky Britten  1 , Julia Frost  1 , Sally Singh  11 , Christopher Hayward  12 , Victoria Eyre  13 , Kevin Paul  14 , Chim C Lang  15 , Karen Smith  16
Affiliations
Randomized Controlled Trial

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

Hasnain M Dalal et al. Eur J Prev Cardiol. 2019 Feb.

Erratum in

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.

Keywords: Cardiac rehabilitation; health-related quality of life; heart failure; home-based; randomized controlled trial; self-management.

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Figures

Figure 1.
Figure 1.
Trial profile. *Per protocol: REACH-HF participant must attend first face-to-face contact with facilitator and at least two facilitator contacts thereafter, at least one of which must be face-to-face. †One REACH-HF and two control participants had completed questionnaires insufficiently to allow scoring of primary outcome. REACH-HF: Rehabilitation EnAblement in CHronic Heart Failure
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References

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