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

Hasnain M. Dalal, Rod S. Taylor (Lead / Corresponding author), Kate Jolly, Russell C. Davis, Patrick Doherty, Jackie Miles, Robin van Lingen, Fiona C. Warren, Colin Green, Jenny Wingham, Colin Greaves, Susannah Sadler, Melvyn Hillsdon, Charles Abraham, Nicky Britten, Julia Frost, Sally Singh, Christopher Hayward, Victoria Eyre, Kevin PaulChim C. Lang, Karen Smith, REACH-HF investigators

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Abstract

Background: Cardiac rehabilitation (CR) improves health-related quality of life (HRQOL) and reduces hospitalizations in patients with heart failure (HF), but international uptake of CR for HF remains low.

Design and methods: The aim of this multicenter randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and homebased CR programme to usual care for adults with HF 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% CI –10.6 to –0.7) in favor of the REACH-HF intervention group (p = 0.025). With 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 to 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 programs to address current low CR uptake rates for HF.
Original languageEnglish
Pages (from-to)262-272
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Volume26
Issue number3
Early online date10 Oct 2018
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Cardiac rehabilitation
  • health-related quality of life
  • heart failure
  • home-based
  • randomized controlled trial
  • self-management

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