Implementation of an evidence-based home cardiac rehabilitation programme for heart failure patients and their caregivers in Scotland (SCOT:REACH-HF )
Heart failure is a serious condition that affects nearly one million people in the UK, and its prevalence is increasing. Heart failure means that the heart is unable to pump blood around the body properly (usually because the heart has become too weak or stiff). This often results in significant fatigue, breathlessness and potentially dangerous accumulation of fluid in bodily tissues, effects which can have a very negative impact on quality of life. Moreover, the cost of heart failure to the NHS is estimated at £2 billion annually.
Existing research shows that cardiac rehabilitation (e.g. specially tailored exercise programmes) is highly effective, cost-effective and integral to comprehensive care of people with heart failure. Despite national guidelines recommending that everyone with heart failure should receive rehab, currently only a small proportion are offered or participate in this rehab. Most of what is offered is hospital-based, which has been found to be a barrier to participation. The Covid-19 pandemic has significantly limited what rehab can be offered to anyone with cardiovascualr disease. At present, home-based programme remains the only feasible option for many cardiac rehab services, as well as for more clinically vulnerable patients.
Home-based rehab can provide an accessible and cost-effective approach to improving uptake.
We have co-developed a home-based CR intervention based on health behaviour change theory: Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF). A multi-centre RCT found the addition of REACH-HF to usual medical care had a positive impact on participants living with heart failure.
SCOT:REACH-HF seeks to understand what shapes the implementation of the REACH-HF programme in a real-world setting. With six NHS ‘beacon sites’ across Scotland (running in parallel to other beacon sites in England and Northern Ireland), we aim to inform the future implementation of this home-based programme for people with heart failure and their caregivers in Scotland.
SCOT:REACH-HF is funded by Heart Research UK.
NHS Ayrshire and Arran
NHS Forth Valley