Home rehabilitation helps people with heart failure achieve better quality of life, study finds

REACH-HF was co-designed by clinicians, academics, patients and caregivers to help increase participation in rehabilitation therapies by bringing care into patients’ own homes including a programme of exercise and well-being.

A new home-based rehabilitation programme could help thousands of heart failure patients to achieve a better quality of life, research carried out in collaboration with the University of Birmingham has found.

A new study has found that the Rehabilitation Enablement in CHronic Heart Failure (REACH-HF) programme, led by the University of Exeter and the Royal Cornwall Hospitals NHS trust, significantly improved quality of life and is deliverable within NHS cost guidelines.

REACH-HF was co-designed by clinicians, academics, patients and caregivers to help increase participation in rehabilitation therapies by bringing care into patients’ own homes including a programme of exercise and well-being.

The programme was aimed at patients with heart failure with reduced ejection fraction - where their heart muscles do not contract as effectively as they should resulting in poorer circulation of blood around the body – which affects approximately half of heart failure patients.

The five-year study received £2million in funding from the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme, with contributions also from a number of clinical and academic partners from across the UK including Exeter, Gwent, Birmingham, York, and Dundee.

Approximately 900,000 people are affected by heart failure in the UK, costing the NHS £1bn per year. Although NICE recommends 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.

In this study, the researchers monitored 216 patients with an average aged of 70 who participated in the REACH-HF programme for 12 months, and found that their quality of life was significantly improved compared to patients not undergoing rehabilitation.

In addition to education and psychological support the rehab programme included chair-based or walking exercises three or more times a week. The cost of the intervention was £418 per patient - within the £477 that the NHS currently pays for rehabilitation.

The study, jointly led by Professor Rod Taylor and Dr Hasnain Dalal of the University of Exeter, was published today in the European Journal of Preventive Cardiology.

Dr Hasnain Dalal, of the University of Exeter and the Royal Cornwall Hospitals NHS Trust, said: “Although previous hospital-based studies have shown an improvement in quality of life and reduction in hospital admissions for patients receiving cardiac rehabilitation, heart failure patients often find it difficult to attend rehabilitation centres in hospitals.

“This tends to be due to lack of access to transport, poor mobility, and other health problems and can lead to isolation and depression.

“Our research gives us hope that this more accessible rehabilitation intervention will increase participation and improve patients’ quality of life.”

Professor Rod Taylor, of the University of Exeter Medical School said: “In this study we demonstrate the effectiveness of the REACH-HF programme on the quality of life, and ability of patients to better manage their condition.

“We now we hope to see REACH-HF rolled out across the UK as genuine menu option for all cardiac rehab programmes which will help improve uptake to rehabilitation and improve the quality of life of people with HF and their caregivers.”

Professor Colin Greaves of the University of Birmingham's School of Sport, Exercise and Rehabilitation who led the design team that developed the REACH-HF intervention, said: “The results of this study come at a very interesting time, when rehabilitation services are feeling stretched all around the UK.

“More resources are needed to expand cardiac rehabilitation services to allow access for all people with heart failure as well as all the other patients currently receiving cardiac rehabilitation.

“Recent estimates suggest that the UK needs an additional 210,000 cardiac rehab places each year to treat everyone who is eligible.

“We know these treatments are effective and can have a huge impact on peoples’ lives following heart attacks or the diagnosis of heart failure

“The results of this study provide compelling evidence that a home-based programme of exercise and self-care support for people with heart failure and their caregivers should now be rolled out as part of national NHS policy.”

Ends

For more information please contact:

  1. Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office on +44 (0) 7789 921 165. 
  2. Louise Vennells, Press and Media Manager, University of Exeter Medical School, +44 (0)1392 724927 or 07768 511866, l.vennells@exeter.ac.uk

Notes to Editors

  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
  • Dalal et al (2018). ‘The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicentre randomized controlled trial’. European Journal of Preventive Cardiology. DOI: 10.1177/2047487318806358
  • The University of Exeter Medical School is improving the health of the South West and beyond, through the development of high quality graduates and world-leading research that has international impact.
  • This research was funded by United Kingdom’s National Institute for Health Research (NIHR) Programme Grants for Applied Research [grant number RP-PG-1210-12004].
  • The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health and Social Care, the NIHR:
  1. funds high quality research to improve health
  2. trains and supports health researchers
  3. provides world-class research facilities
  4. works with the life sciences industry and charities to benefit all
  5. involves patients and the public at every step.

CASE STUDY:

When Chris Edgeler’s GP suggested he take part in a rehabilitation programme following a heart attack, he initially thought it wasn’t for him. Despite his diagnosis of heart failure, he felt it would be hard to engage.

“I’m not the type of person to sit in groups talking about my feelings,” said Chris, a retired council worker. “I would never have gone to the gym. The home-based rehabilitation programme was perfect for me. It even involved my wife. I hadn’t realised that she was scared that I was going to drop dead, and previously everything we’d taken part in was all about me and my care. This helped us both understand how we were feeling.”

Six years on, and Chris, now 58, has given up smoking and is eating more healthy foods. “The programme is really clear and easy to follow. The relaxation techniques are great too. One night they helped me to calm down and avoid ringing 999 when I was feeling unwell. It’s a brilliant programme and it’s worked so well for me.”