Successful home-based heart rehabilitation programme rolled out

Research has found that the Rehabilitation Enablement in CHronic Heart Failure (REACH-HF) programme, developed by a collaboration led by the University of Exeter and the Royal Cornwall Hospitals NHS trust, significantly improved quality of life. Rehabilitation is also linked to better health outcomes for patients. Last month, a new study has concluded that the Reach-HF programme is cost-effective to deliver in the NHS. In a letter to the editor to the European Journal of Preventive Cardiology, which published the study, the authors have called on commissioners to act now to give patients an alternative to hospital based programmes so as to increase the very low uptake of rehab in patients with heart failure.

Four NHS trusts have now been identified as “beacon” sites, to roll out the findings from the previous trial. This staged roll-out of REACH-HF will help answer whether the benefits to quality of life seen in the trial also apply to real-world healthcare settings. It will mean the programme can be refined, monitored and evaluated before it is extended further. The sites are: University College Hospitals London NHS Foundation Trust, Belfast Health and Social Care Trust, Gloucestershire Care Services, and Wirral Community NHS Foundation Trust. They were chosen for their geographical spread, commitment to offering home based care and having systems of providing high quality data for the National Audit of Cardiac Rehabilitation.

Dr Hasnain Dalal, of the University of Exeter and the Royal Cornwall Hospitals NHS Trust, said: “It’s really gratifying to see an innovation developed as part of NHS funded research will now be rolled out as a pilot to patients with heart failure in the ‘real world’. We now know it improves quality of life and that it’s cost-effective to deliver a home based programme. Rehabilitation is so important to help people with heart failure live as well as possible.”

Professor Rod Taylor, at the Universities of Exeter and Glasgow, said: “This programme overcomes many of the obstacles that often stop them attending hospital-based programmes, such as the logistics of getting there and offers an alternative option for patients..”

Prof Martin R Cowie, Consultant Cardiologist at Imperial College London (Royal Brompton Hospital) and Non-Executive Director of the National Institute of Health Care Excellence (NICE) said:
“It is vital that the health service develops better rehabilitation services that are matched to the needs of those who stand to gain so much benefit. By moving from a randomised trial to a “real world” roll out, the REACH HF programme will be able to demonstrate the value of their tailored home-based programme to many people living with heart failure in the UK. This looks like a good use of resources and should lead to important benefits for all concerned.”

The programme includes: chair-based exercises that can easily be done at home, a walking plan, audio with relaxation techniques 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. A caregivers’ manual aims 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. A training course for clinician’s to enable the above in practise is core to the delivery of the overall programme.

The programme was co-designed by clinicians, academics, patients and caregivers in the UK 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 significant contributions from five NHS hospitals (Cornwall, Gwent, Birmingham, York and Dundee) and three leading UK universities (the universities of Exeter, Birmingham and York)along with input from the Heart Manual Department, NHS Lothian. The research has been supported by the Collaboration for Leadership in Applied Health Research and Care South West Peninsular (PenCLAHRC)

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 NHS Long Term Plan has also set an ambitious target of increasing access to rehabilitation to 85% of eligible cardiac patients by 2028.

The REACH-HF programme is a home-based rehabilitation programme including tailored exercise and well-being interventions 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 related surgery. The Heart Manual Department will be hosting the three day training of the beacon site facilitators in May 2019. Additional training dates have been set up for September 2019 due to enthusiastic response from other NHS sites who would like to use REACH-HF in their services and are able to fund this themselves. Further information about the beacon site project and the REACH-HF study can be obtained by emailing Dr Sam van Beurden, Post-Doctoral Research Associate at the University of Exeter Medical School : reach-hf@exeter.ac.uk