A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: REACH-HFpEF pilot study

Hasnain M Dalal; Chim C Lang; Karen Smith; Jenny Wingham; Victoria Eyre; Colin J Greaves; Fiona C Warren; Colin Green; Kate Jolly; Russell C Davis; Patrick Doherty; Jackie Austin; Nicholas Britten; Charles Abraham; Robin Van Lingen; Sally Singh; Kevin Paul; Melvyn Hillsdon; Susannah Sadler; Christopher Hayward; Rod S Taylor; On behalf of the REACH-HF Investigators

doi:10.3399/bjgp18X697013

Abstract

Background Home-based models of cardiac rehabilitation may overcome suboptimal rates of participation.

Aim This 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.

Method Patients 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.

Results We 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.

Conclusion Our 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.

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A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: REACH-HFpEF pilot study

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A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: REACH-HFpEF pilot study

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