The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicenter randomized controlled trial

Background: Cardiac rehabilitation (CR) improves health-related quality of life (HRQOL) and reduces hospitalizations in patients with heart failure (HF), but international uptake of CR for HF remains low.

Design and methods: The aim of this multicenter randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based CR programme to usual care for adults with HF with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQOL (Minnesota Living with Heart Failure questionnaire [MLHFQ]) at 12 months compared with usual care alone.

Results: The study recruited 216 participants, predominantly men (78%) with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of –5.7 points (95% CI –10.6 to –0.7) in favor of the REACH-HF intervention group (p = 0.025). With exception of patient self-care (P < 0.001) there was no significant difference in other secondary outcomes including clinical events (P > 0.05) at follow up compared to usual care. The mean cost of the REACH-HF intervention was £418 per participant.

Conclusions: The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programs to address current low CR uptake rates for HF.ISRCTN86234930

Key words: cardiac rehabilitation, health-related quality of life, heart failure, home-based, randomized controlled trial, self-management