3 Implementing a home-based cardiac rehabilitation programme for people with heart failure and their caregivers: findings from the SCOT: REACH-HF Study

BackgroundDespite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID-19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR self-management programme. The SCOT:REACH-HF study was designed to provide the understanding of real-world implementation needed for NHS-wide roll-out in a Scottish context.AimTo 1) compare outcome improvements and delivery costs with those identified in the RCT; and 2) identify facilitators of and barriers to real-world implementation.MethodsA mixed-method implementation study of REACH-HF delivery across six NHS Scotland areas in 2021-22. Health professionals were trained to facilitate delivery of the 12-week programme. We assessed patient- and caregiver-reported outcomes (including health-related quality of life, psychological wellbeing) pre-and post-REACH-HF participation. Primary outcome: Minnesota Living with Heart Failure Questionnaire (MLHF). 136 adults with reduced ejection fraction HF (HFrEF) were recruited, and 101 completed follow-up. 54 participants nominated caregivers, 26 of whom completed follow-up. Qualitative interviews with 20 key health professionals (primarily REACH-HF facilitators) were subject to thematic analysis to explore barriers to and facilitators of implementation. Fidelity, contextual, and economic data were also collected.ResultsREACH-HF participation resulted in significant gains in health-related quality of life, as assessed by the MLHF, PROM-CR+, and EQ-5D-5L, and Self-Care of Heart Failure Index (SCHFI). MLHF improvements were both statistically significant and met the minimum clinically important difference in 63% of participants (see figure 1). Interviewees were largely positive about REACH-HF – considering it to have ‘filled a gap’ when no other CR was available – and key issues to support future roll-out were identified.Abstract 3 Figure 1MLHF total score pre-post mean difference (including minimum clinically important difference (MCID))ConclusionOur findings support the scaled roll-out of REACH-HF. This would offer people with HFrEF, and their families and friends, an accessible alternative to centre-based CR.