Re: New evidence based rehabilitation for heart failure could improve access and poor uptake
Clinicians and commissioners should welcome the recent publication of a UK based multicentre trial on home-based cardiac rehabilitation  which responds to the updated NICE guidance on chronic heart failure reviewed in the BMJ. 
The BMJ first highlighted the importance of cardiac rehabilitation in heart failure in a letter from our group in 2010.  Subsequently, the BMJ published a clinical review where Kevin Paul, a patient who has been part of the Rehabilitation Enablement in CHronic Heart Failure (REACH-HF) investigator group, detailed his involvement in a podcast accompanying the online version of our paper (https://soundcloud.com/bmjpodcasts/cardiac-rehab-patient).
We believe REACH HF to be the largest trial of home based rehabilitation in heart failure with reduced ejection fraction. The trial provides important new evidence of clinical effectiveness for a novel home-based rehabilitation programme that was co-developed by clinicians, academics, caregivers and patients. The comprehensive intervention includes chair-based exercises, a patient manual with advice on lifestyle and medication together with an interactive progress tracker to record symptoms and activity. There is also a manual for use by caregivers aimed to increase their understanding of heart failure. 
Although the 2010 NICE guidelines (CG 108) recommended that adults with heart failure should receive rehabilitation, the 2015-16 national audit in England and Wales showed that less than 20% are referred for rehabilitation.  With this in mind, the updated 2018 NICE guidelines recommend that adults with heart failure are offered the option of a personalised home-based rehab programme that is easily accessible. 
The results of the REACH HF trial (n=216) show that it is possible to significantly improve patients’ health related quality of life and that the intervention has a cost of £418 per patient,  within the NHS tariff for cardiac rehabilitation.
The roll out of the REACH-HF intervention provides an opportunity for service providers and commissioners to offset the current inequity in access to rehabilitation by patients with heart failure both in the UK and abroad. We are already working with key stakeholders for future adoption of the REACH-HF programme in the NHS, starting with four enhanced dissemination beacon sites in 2019.
Hasnain M Dalal, Rod S Taylor, Kate Jolly, Patrick Doherty Colin Greaves and Jenny Wingham on behalf of the REACH-HF study investigators
Conflict of interest: HD and RT were topic specific advisors in cardiac rehabilitation to the 2018 NICE chronic heart failure guideline group and are co – chief investigators of the REACH HF Study
1.Dalal HM ,Taylor RS et al . The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: the REACH-HF multicentre randomized controlled trial. Eur J Prev Cardiol 2018 doi: 10.1177/2047487318806358
2. Chronic heart failure in adults: summary of updated NICE guidance. BMJ 2018;362:k3646; doi10.1136/bmj.k3646 ( 24 September 2018)
3. Dalal H. Don’t forget rehabilitation. BMJ 2010;341 doi: 10.1136/bmj.c4286
4. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ 2015;351:h5000. doi: 10.1136/bmj.h5000 [published Online First: 2015/10/01]
5. Greaves CJ, Wingham J, Deighan C, et al. Optimising self-care support for people with heart failure and their caregivers: Development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping. Pilot Feasibility Stud 2016; 2: 37.
6. Donkor A et al. National heart failure audit. London: Healthcare Quality Improvement Partnership, 2017.
Competing interests: HMD and RST were topic specific advisors in cardiac rehabilitation to the 2018 NICE chronic heart failure guideline group and are the co – chief investigators of the REACH HF Study funded by the NIHR Programme Grants for Applied Research (grant number RP-PG-1210-12004)