Home-based rehabilitation for heart failure with reduced ejection fraction: the REACH HF multicentre RCT

Abstract

BackgroundCardiac rehabilitation (CR) improves health-related quality of life (HRQOL) and reduces hospitalisations in patients with heart failure (HF), but international uptake of CR for HF remains low.AimTo compare the REACH-HF (Rehabilitation EnAblement EnAblement in CHronic Heart Failure) intervention: a facilitated self-care and home-based CR programme to usual care (UC) for adults with HF with reduced ejection fraction (HFrEF) and to assess the long-term cost-effectiveness of the intervention. The primary hypothesis was that the addition of the REACH-HF intervention to UC would improve disease-specific HRQOL (Minnesota Living with Heart Failure questionnaire [MLHFQ]) at 12 months compared with UC alone.MethodMulticentre randomised trial.ResultsThere were 216 participants: 78% male, average age 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 favour of the REACH-HF intervention group (P = 0.025). The mean cost of the REACH-HF intervention was £418 per participant, which was associated with a per patient mean quality-adjusted life year (QALY) gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720.ConclusionThe REACH-HF facilitated intervention was clinically superior in disease-specific HRQoL at 12 months and economic modelling shows that it is cost-effective. REACH-HF offers an affordable alternative to traditional centre-based programmes to address current low CR uptake rates for HF.