A new study has found that the Rehabilitation Enablement in CHronic Heart Failure (REACH-HF) programme, led by the University of Exeter and the Royal Cornwall Hospitals NHS trust, significantly improved quality of life and is deliverable within NHS cost guidelines.
The programme was co-designed by clinicians, academics, patients and caregivers to help increase participation in rehabilitation therapies for heart failure patients by bringing care into their own homes. The five year study received £2million in grant funding from the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme with contributions from a number of clinical and academic partners from across the UK including Exeter, Gwent, Birmingham, York, and Dundee.
Approximately 900,000 people are affected by heart failure in the UK, costing the NHS £1bn per year. Although NICE recommend that all people with heart failure should receive rehabilitation, less than one in 10 do.
With this in mind, the new 2018 heart failure guidelines from NICE recommend that patients are offered the option of a personalised home-based rehab programme that is easily accessible.
The rehabilitation programme includes: a chair-based exercise that can easily be done at home and a manual with advice on lifestyle and medication. Also included is an interactive booklet designed to facilitate learning from experience and record symptoms, physical activity and other actions related to self-care. There is another manual for use by caregivers aimed to increase their understanding of heart failure and aspects such as relaxation techniques, helping people come to terms with both the physical and psychological impact of heart failure.
In the study, researchers monitored patients participating in the programme for 12 months, and found that their quality of life was significantly improved compared to patients not undergoing rehabilitation. The cost of the intervention was £418 per patient (within the current price that the NHS pays for rehabilitation: £477).
This high-calibre multi-author study, jointly led by Professor Rod Taylor, and Dr. Hasnain Dalal of the University of Exeter, has just been published in the European Journal of Preventive Cardiology.
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, 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, l 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."
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Hasnain M Dalal et al, The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial, European Journal of Preventive Cardiology (2018). DOI: 10.1177/2047487318806358