Rehabilitation Enablement in Chronic Heart Failure

    • Rehabilitation Enablement in Chronic Heart Failure

    REACH-HF

    The REACH HFrEF multicentre RCT

    Posted by sv333

    22 May 2019

    The findings of this trial were published online in the European Journal of Preventive Cardiology on 11th October 2018.The key finding was that heart failure patients quality of life was significantly improved compared to patients not undergoing rehabilitation. The cost of the intervention was ÂŁ418 per patient (within the current price that the NHS pays for rehabilitation: ÂŁ477).

    This multi-author study, jointly led by Professor Rod Taylor of the University of Exeter and Dr Hasnain Dalal of the University of Exeter and the Royal Cornwall Hospitals NHS Trust, said: “Although previous hospital-based studies have shown an improvement in quality of life and reduction in hospital admissions for patients receiving cardiac rehabilitation, heart failure patients often find it difficult to attend rehabilitation centres in hospitals. This tends to be due to lack of access to transport, poor mobility, and other health problems and can lead to isolation and depression. Our research gives us hope that this more accessible rehabilitation intervention will increase participation and improve patients’ quality of life.”

    The REACH-HF programme is a home-based programme of exercise and well-being for patients with heart failure and their caregivers which was designed to make rehabilitation more accessible. It builds on the existing Heart Manual (NHS Lothian), used with patients after a heart attack or surgery.

    The study shows significant clinical benefit for participants when compared to patients not undergoing rehabilitation.

    REACH-HF is aimed at patients with heart failure with reduced ejection fraction (HFrEF), where their heart muscles do not contract as effectively as they should, resulting in poorer circulation of blood around the body. This affects approximately half of heart failure patients.

    The study involved 216 patients, with an average age of 70, Those undertaking the REACH-HF were assisted by specially trained cardiac nurses or physiotherapists for 12 weeks. In addition to education and psychological support the rehab programme included chair-based or walking exercises three or more times a week. The patients’ quality of life was then monitored over the course of a year using a disease specific ‘Health Related Quality of Life’ questionnaire – the Minnesota Living with Heart Failure Questionnaire.

    Professor Rod Taylor, of the University of Exeter Medical School said: “In this study we demonstrate the effectiveness of the REACH-HF programme on the quality of life, and ability of patients to better manage their condition.

    “We now we hope to see REACH-HF rolled out across the UK as genuine menu option for all cardiac rehab programmes which will help improve uptake to rehabilitation and improve the quality of life of people with HF and their caregivers.”

    Professor Colin Greaves of the University of Birmingham who led the design team that developed the REACH-HF intervention while he was at the University of Exeter, said: “The results of this study provide compelling evidence that a home-based programme of exercise and self-care support for people with heart failure and their caregivers should now be rolled out as part of national NHS policy.”

    The study is entitled ‘The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicentre randomized controlled trial’. The full list of authors is Hasnain M. Dalal, Rod S. Taylor, Kate Jolly, Russell C. Davis, Patrick Doherty, Jackie Miles, Robin van Lingen, Fiona C. Warren, Colin Green, Jennifer Wingham, Colin Greaves, Susannah Sadler, Melvyn Hillsdon, Charles Abraham, Nicky Britten, Julia Frost, Sally Singh, Christopher Hayward, Victoria Eyre, Kevin Paul, Chim C. Lang, and Karen Smith.

    Case study: “I would never have gone to the gym”

    When Chris Edgeler’s GP suggested he take part in a rehabilitation programme following a heart attack, he initially thought it wasn’t for him. Despite his diagnosis of heart failure, he felt it would be hard to engage.

    “I’m not the type of person to sit in groups talking about my feelings,” said Chris, a retired council worker. “I would never have gone to the gym. The home-based rehabilitation programme was perfect for me. It even involved my wife. I hadn’t realised that she was scared that I was going to drop dead, and previously everything we’d taken part in was all about me and my care. This helped us both understand how we were feeling.”

    Six years on, and Chris, now 58, has given up smoking and is eating more healthy foods. “The programme is really clear and easy to follow. The relaxation techniques are great too. One night they helped me to calm down and avoid ringing 999 when I was feeling unwell. It’s a brilliant programme and it’s worked so well for me.”

    Read the full paper here

     

    Protocol for Work Package 3 (the main trial)

    The rationale and protocol for the multicentre randomised controlled trial of the HF Manual in patients and caregivers with systolic heart failure.

    Taylor RS, Hayward C, Eyre V, Austin J, Davies R, Doherty P, Jolly K, Wingham J, Van Lingen R, Abraham C, Green C, Warren FC, Britten N, Greaves CJ, Singh S, Buckingham S, Paul K, Dalal H; REACH-HF investigators. Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial. BMJ Open, 2015 Dec,5(12):e009994. Read the full rationale and protocol here.

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