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Successful home-based heart rehabilitation programme rolled out

Posted on April 8th 2019

A new rehabilitation programme, which helps heart failure patients achieve better quality of life from the comfort of their own homes will now be rolled out at four NHS centres across the UK.

Collaboration for Leadership in Applied Health Research and Care South West Peninsular
(PenCLAHRC) supported 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 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.

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 patients attending hospital-based programmes, such as the logistics of getting there and offers an alternative option…”

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, facilitated by a trained cardiac nurse or physiotherapist and developed from health behaviour change theory, was co-developed with patients, caregivers and clinicians to enable care to be brought into homes. Participants were supported in their rehabilitation via face-to-face and telephone sessions, home-based exercise programmes and a patient progress tracker. Support was also offered to caregivers to help them better understand heart failure and the importance of their own physical and mental well-being when providing care. A training course for clinician’s to facilitate the programme is also a key part of its delivery.

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. Research was supported by 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.

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