Abstract
BackgroundHome-based models of cardiac rehabilitation may overcome suboptimal rates of participation.AimThis study sought to assess the feasibility and acceptability of a novel healthcare professional facilitated home-based comprehensive self-management REACH-HF rehabilitation intervention for patients with heart failure with preserved ejection fraction (HFpEF) and their caregivers.MethodPatients were randomised 1 to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group). Outcomes were collected at baseline, 3 and 6 months post-randomisation. Outcomes were also collected in caregivers.ResultsWe enrolled 50 symptomatic patients with a left ventricular ejection fraction ≥ 45% (mean age: 73.9 years, 54% female: 96% in NYHA II/III) and 21 caregivers. Study retention (90%) and intervention uptake (92%) were excellent. At 6 months, a number of patient outcomes showed a potential direction of effect in favour of the intervention group, including the primary outcome of Minnesota Living with Heart Failure Questionnaire total score (between group mean difference: −11.5, 95% confidence interval: −22.8 to 0.3). A total of 11 (4 intervention, 7 control) patients experienced a hospital admission over the 6 months follow up with 4 (all control patients) of these admissions being HF-related. Improvements were seen in a number intervention caregiver mental health and burden compared to control.ConclusionOur findings support the feasibility and rationale for the delivering the REACH-HF facilitated home-based rehabilitation intervention for patients with HFpEF and their caregivers and progression to a full multicentre randomised clinical trial to test the clinical and cost-effectiveness of this novel intervention.
Highlights
Home-based cardiac rehabilitation may overcome suboptimal rates of participation
A recent meta-analysis of eight randomised trials in 317 patients with heart failure with preserved ejection fraction (HFpEF) found exercise-based cardiac rehabilitation (CR) significantly improved exercise capacity and health-related quality of life (HRQoL) compared with usual care.[7]
The overarching aim of this study was to assess the feasibility of undertaking a definitive randomised trial to assess the clinical effectiveness and cost-effectiveness of the REACH-heart failure (HF) intervention in patients with HFpEF and their caregivers
Summary
Home-based cardiac rehabilitation may overcome suboptimal rates of participation. The overarching aim of this study was to assess the feasibility and acceptability of the novel Rehabilitation EnAblement in CHronic Hear Failure (REACH-HF) rehabilitation intervention for patients with heart failure with preserved ejection fraction (HFpEF) and their caregivers. Ejection fraction (HFpEF).[1] In contrast to HF with reduced ejection fraction (HFrEF), the prevalence of HFpEF is increasing.[2] Importantly, the substantial burden from HFpEF appears to be similar to HFrEF, measured by exercise intolerance, poor health-related quality of life (HRQoL), mortality, increased hospital admissions and higher healthcare costs.[3] drug and device therapy have helped to improve outcomes in HFrEF, prognosis in HFpEF remains unchanged, with no large-scale randomised trial demonstrating significant treatment benefits that alter the natural course of HFpEF or lower mortality.[4 5] systematic reviews and meta-analyses have shown promising evidence for the benefit of exercise-based cardiac rehabilitation (CR) in HFpEF.[6 7] A recent meta-analysis of eight randomised trials in 317 patients with HFpEF found exercise-based CR significantly improved exercise capacity and HRQoL compared with usual care.[7] The CR programmes undertaken in these trials were predominantly group-based, supervised and delivered in centre-based settings
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