Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)

Abstract

Aims Alternative models of cardiac rehabilitation (CR) are required to improve CR access and uptake. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a comprehensive home-based rehabilitation and self-management programme, facilitated by trained health professionals, for people with heart failure (HF) and their caregivers. REACH-HF was shown to be clinically effective and cost-effective in a multicentre randomised trial. The SCOT:REACH-HF study assessed implementation of REACH-HF in routine clinical practice in NHS Scotland. Methods & results A mixed-method implementation study was conducted across six regional Health Boards. Of 136 people with HF and 56 caregivers recruited, 101 people with HF and 26 caregivers provided four-month follow-up data, after participating in the 12-week programme. Compared with baseline, REACH-HF participation resulted in substantial gains in the primary outcome of health-related quality of life, as assessed by the Minnesota Living with Heart Failure Questionnaire (mean difference: -9.8, 95% CI: -13.2 to -6.4, P < 0.001). Improvements were also seen in secondary outcomes (PROM-CR+; EQ-5D-5L; Self-Care of Heart Failure Index (SCHFI) domains of maintenance and symptom perception; Caregiver Contribution to Self-Care (CC-SCHFI) domains of symptom perception and management). Twenty qualitative interviews were conducted with 11 REACH-HF facilitators, five supporting clinicians, and four national stakeholders. Interviewees were largely positive about REACH-HF, considering it to have ‘filled a gap’ where centre-based CR was not an option. Key issues to support future roll-out were also identified. Conclusion Our findings support wider roll-out of REACH-HF as an alternative to centre-based models, to improve CR access and uptake for people with HF.

Integration of a Smartphone HF-Dedicated App in the Remote Monitoring of Heart Failure Patients with Cardiac Implantable Electronic Devices: Patient Access, Acceptance, and Adherence to Use

“…Of note, caregivers greatly increased the penetration of app technology in our population, often being frequent and expert users of apps who were also willing to invest time in patient care (in the same way as the patient would). This finding is concordant with the literature reporting the fundamental role of caregivers in the pathway and outcomes of heart failure patients [32,33].…”

Interventions for Caregivers of Heart Disease Patients in Rehabilitation: Scoping Review

“…Accordingly, patients and caregivers dyads need proper support and supervision from health professionals and society to address their physical, emotional, and psychosocial needs [ 29 , 30 ]. In the study by Purcell and colleagues [ 31 ], the results from their rehabilitation home-based program directed to the patient/caregiver dyad highlighted the gains for the caregiver in terms of knowledge about the symptoms of the disease and lower levels of depression, reinforcing the findings.…”

Exercise training in heart failure

“…For example, following demonstration of its clinical and cost effectiveness in a multicentre trial and economic modelling, the REACH-HF home-based programme is now being implemented across the UK NHS for stable patients post-discharge. [37][38][39] It is important to note that the majority of evidence of home/digitally-supported models of • Prior to commencing exercise training, assessments to exclude contraindications to exercise, determine risk level, and evaluations of exercise capacity should be performed.…”