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

TY - JOUR

T1 - The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction

T2 - the REACH-HF multicenter randomized controlled trial

AU - Dalal, Hasnain M.

AU - Taylor, Rod S.

AU - Jolly, Kate

AU - Davis, Russell C.

AU - Doherty, Patrick

AU - Miles, Jackie

AU - van Lingen, Robin

AU - Warren, Fiona C.

AU - Green, Colin

AU - Wingham, Jenny

AU - Greaves, Colin

AU - Sadler, Susannah

AU - Hillsdon, Melvyn

AU - Abraham, Charles

AU - Britten, Nicky

AU - Frost, Julia

AU - Singh, Sally

AU - Hayward, Christopher

AU - Eyre, Victoria

AU - Paul, Kevin

AU - Lang, Chim C.

AU - Smith, Karen

AU - REACH-HF investigators

PY - 2019/2

Y1 - 2019/2

N2 - 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.

AB - 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.

KW - Cardiac rehabilitation

KW - health-related quality of life

KW - heart failure

KW - home-based

KW - randomized controlled trial

KW - self-management

U2 - 10.1177/2047487318806358

DO - 10.1177/2047487318806358

M3 - Article

C2 - 30304644

SN - 2047-4873

VL - 26

SP - 262

EP - 272

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 3

ER -