European Primary Care Cardiovascular Society

Home-based cardiac rehabilitation associated with improved HRQoL in HFrEF patients

The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial

Dalal HM, Taylor RS, Jolly K et al. - Eur J Prev Cardiol 2018; 0(00) 1–11

Introduction and methods

Although group- or center-based cardiac rehabilitation is recommended to improve health-related quality of life (HRQoL) in patients with heart failure (HF) [1-3], less than 10% of American HF patients and 20% of European HF patients participate in cardiac rehabilitation [4,5]. Home-based cardiac rehabilitation programs can widen access and have been demonstrated to be as effective as group- or hospital-based cardiac rehabilitation after myocardial infarction and coronary revascularization, and with similar costs [6]. However, there is little evidence available with regard to clinical and cost-effectiveness of home-based cardiac rehabilitation in patients with HF [7] and none of the interventions have involved caregivers or have been co-developed with patients, caregivers or clinicians.

The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) was a multicenter, two parallel group, randomized, superiority trial that assessed the effect of cardiac rehabilitation [8] for 12 weeks on top of usual care (n=107) versus usual care alone (n=109) on quality of life in patients aged ≥18 years with confirmed HFrEF on echocardiography or angiography within the preceding five years. Those who had undertaken cardiac rehabilitation within 12 months prior to enrolment, or with a contraindication to exercise testing or exercise training were excluded.

The home-based intervention included a mixture of face-to-face and telephone contacts over 12 weeks. Usual care was defined as medical management according to national and local guidelines, including specialist HF nurse care. Participants were stratified based on investigator site and baseline plasma N-terminal proB-type natriuretic peptide (BNP) levels (≤2 vs. >2 ng/ml).

The primary outcome was disease-specific HRQoL at 12 months measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ).

Main results

Primary outcome

Secondary outcomes

Costs

Conclusion

This randomized trial showed superior and clinically important improvements in disease-specific HRQoL and self-management at 12 months with the affordable, novel REACH-HF home-based cardiac rehabilitation intervention for 12 weeks on top of standard care in HFrEF patients. Thus, this can be an additional option for patients, clinicians and healthcare commissioners to address current low rates of uptake of center-based cardiac rehabilitation.

References

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