Abstract
BackgroundWhilst almost 50% of heart failure (HF) patients have preserved ejection fraction (HFpEF), evidence-based treatment options for this patient group remain limited. However, there is growing evidence of the potential value of exercise-based cardiac rehabilitation. This study reports the process evaluation of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention for HFpEF patients and their caregivers conducted as part of the REACH-HFpEF pilot trial.MethodsProcess evaluation sub-study parallels to a single-centre (Tayside, Scotland) randomised controlled pilot trial with qualitative assessment of both intervention fidelity delivery and HFpEF patients’ and caregivers’ experiences. The REACH-HF intervention consisted of self-help manual for patients and caregivers, facilitated over 12 weeks by trained healthcare professionals. Interviews were conducted following completion of intervention in a purposeful sample of 15 HFpEF patients and seven caregivers.ResultsQualitative information from the facilitator interactions and interviews identified three key themes for patients and caregivers: (1) understanding their condition, (2) emotional consequences of HF, and (3) responses to the REACH-HF intervention. Fidelity analysis found the interventions to be delivered adequately with scope for improvement in caregiver engagement. The differing professional backgrounds of REACH-HF facilitators in this study demonstrate the possibility of delivery of the intervention by healthcare staff with expertise in HF, cardiac rehabilitation, or both.ConclusionsThe REACH-HF home-based facilitated intervention for HFpEF appears to be a feasible and a well-accepted model for the delivery of rehabilitation, with the potential to address key unmet needs of patients and their caregivers who are often excluded from HF and current cardiac rehabilitation programmes. Results of this study will inform a recently funded full multicentre randomised clinical trial.Trial registrationISRCTN78539530 (date of registration 7 July 2015).
Highlights
The REACH-heart failure (HF) home-based facilitated intervention for heart failure with preserved ejection fraction (HFpEF) appears to be a feasible and a wellaccepted model for the delivery of rehabilitation, with the potential to address key unmet needs of patients and their caregivers who are often excluded from HF and current cardiac rehabilitation programmes
This paper presents the process evaluation sub-study of the REACH-HFpEF pilot trial that sought to assess the fidelity of intervention delivery and patients’ and caregivers’ experiences of participation in the REACH-HF intervention
The analysis from the current study suggests that HFpEF patients and their caregivers have a number of unmet needs and that the REACH-HF intervention may offer a possible solution to address this gap
Summary
Whilst almost 50% of heart failure (HF) patients have preserved ejection fraction (HFpEF), evidencebased treatment options for this patient group remain limited. Almost 50% of HF patients have preserved ejection fraction (HFpEF), and its prevalence is predicted to grow [1,2,3] These patients are more often women, generally older, with a higher prevalence of co-morbidities (hypertension, diabetes, and atrial fibrillation) and are less likely to have coronary artery disease than those with HF with reduced ejection fraction (HFrEF), their prognosis, associated morbidity, mortality, health-related quality of life (HRQoL), and healthcare costs are comparable [1,2,3]. The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) is a home-based rehabilitation intervention, facilitated by a healthcare professional, and designed to improve selfcare and health-related quality of life in people with HF and their caregivers and to improve their access to CR [12]
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