Digital adaptation of the clinically effective REACH-HF home-based cardiac rehabilitation programme for people living with heart failure (D:REACH-HF)

Background: Despite strong recommendations for heart failure (HF) rehabilitation, participation (uptake and sustained engagement) remains low. Digital interventions may enhance participation and scalability, yet evidence for feasibility in real-world National Health Service settings remains limited. Rehabilitation Enablement in Chronic Heart Failure (REACH-HF), an effective home-based HF cardiac rehabilitation programme, is currently delivered using paper-based manuals with facilitator support.

Objectives: To co-develop and assess the feasibility of a digitally adapted and enhanced version of REACH-HF (D:REACH-HF) with patients, caregivers, and healthcare professionals.

Methods: Following the Person-Based Approach, D:REACH-HF was iteratively co-developed with patients and caregivers in a public involvement group (stage 1) and through qualitative research (stages 2A and 2B). Usability and acceptability of content and design iterations were evaluated with patients, caregivers, and healthcare professionals through think-aloud interviews (n = 20 participants) and feasibility of the fully-functional intervention with facilitation, was assessed with semi-structured interviews at 2–4 and 10–12 weeks (n = 10).

Results: Participants rated D:REACH-HF highly (mean app quality score: 4.02/5), particularly for information credibility and functionality. Key benefits included flexibility, structured self-monitoring, and healthcare professional support. Remote access to patient data enabled more efficient consultations, allowing healthcare professionals to focus on tailoring their support to patient needs. Challenges included technical issues, digital literacy, and engagement variability. All patients requested continued access to the platform, highlighting perceived long-term value.

Conclusion: The D:REACH-HF programme is acceptable to patients and healthcare professionals. Moreover, as indicated by participant reports, it enables and achieves the same perceived benefits as the paper-based REACH-HF. However, evaluation of clinical and cost-effectiveness, implementation, and optimisation of D:REACH-HF for patients from under-researched and underserved communities is needed.