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Home rehabilitation programmes like the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) shortlisted for the BMJ Awards 2020 can play an important role in facilitating patient care during the current Covid-19 outbreak. [1] At a time when patients with heart disease are advised to self-isolate and we are all asked to stay at home and observe social distancing, the ability to exercise and follow a self-care rehabilitation intervention at home is never more pertinent. The REACH-HF programme has been shown to be a cost effective intervention (£1720 per quality adjusted life year [QALY]) that improves the quality of life of patients and helps them and their caregivers to self-manage. [2, 3]
Participation rates in centre-based cardiac rehabilitation programmes are suboptimal, despite current national and international recommendations. [4] Even before the outbreak of Covid-19 there were calls for new strategies to improve participation in cardiac rehabilitation, such as home- or web-based options. [4, 5]
The American College of Cardiology/American Heart Association has recently endorsed home-based rehabilitation [6] and the updated National Institute of Health and Care Excellence (NICE) 2018 guidance on chronic heart failure also states that ‘delivery of home-based rehabilitation may increase access and uptake’.[7]
Home-based programmes can also be delivered digitally and remotely. [8, 9] Internet based access reduces the need for face-to-face contact and an easily accessible platform for healthcare staff to facilitate delivery of rehabilitation programmes and interaction with patients and caregivers, without the need for travel. The British Heart Foundation has just awarded a grant to co-develop an internet based version of REACH HF.
The COVID-19 crisis is moving us in a direction where self-managed home-based interventions are being encouraged, and likely to remain with us, beyond the current pandemic. Research on the implementation of novel cardiac rehabilitation approaches is urgently needed to help guide changes in future cardiac rehabilitation services. We are keen to work with the NHS and key stakeholders to fast track access to REACH-HF to patients and their caregivers at this unprecedented time.
Authors: Hasnain Dalal [a,e] Rod Taylor [b] (co leads REACH-HF study group), Colin Greaves [c], Patrick Doherty [d], Sinead McDonagh [e], Sam van Beurden [e]; on behalf of the REACH-HF Study Group
(a)Royal Cornwall Hospitals NHS Trust, (b)University of Glasgow, (c)University of Birmingham, (d) University of York, (e)University of Exeter
References
[1] Wise J. The BMJ Awards 2020: Stroke and cardiovascular team of the year. BMJ ; 368:m844 doi: 10.1136/bmj.m844
[2] Dalal HM et al. 2018. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. European Journal of Preventive Cardiology, 26 (3), 262–272.
[3] Taylor RS et al. 2019. The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. Eur J Prev Cardiol. 26 (12), 1252-1261
[5] Lavie CJ et al. 2016. Cardiac Rehabilitation and Healthy Life-Style Interventions: Rectifying Program Deficiencies to Improve Patient Outcomes. Journal of the American College of Cardiology, 67, (1), 13–15
[6] Thomas RJ et al. Home- Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 2019;74: 133–53
[7] National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. NICE Guideline NG106. London: NICE; 2018
[8] Deighan C et al. 2017. The Digital Heart Manual: A pilot study of an innovative cardiac rehabilitation programme developed for and with users. Patient Educ Couns, 100 (8), 1598–1607
[9] Maddison R et al. 2019. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart, 105 (2), 122–129
Competing interests:
No competing interests
28 March 2020
Hasnain M Dalal
Former GP and clinical researcher, Honorary Clinical Associate Professor
Rod Taylor [b] (co lead REACH-HF study group), Colin Greaves [c], Patrick Doherty [d], Sinead McDonagh [e], Sam van Beurden [e]; on behalf of the REACH-HF Study Group
University of Exeter Medical School, Truro Campus
Knowledge Spa, Royal Cornwall Hospital NHS Trust, Truro, TR1 3 HD
Re: The BMJ Awards 2020: Stroke and cardiovascular team of the year :Home rehabilitation and Covid-19
Dear Editor
Home rehabilitation programmes like the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) shortlisted for the BMJ Awards 2020 can play an important role in facilitating patient care during the current Covid-19 outbreak. [1] At a time when patients with heart disease are advised to self-isolate and we are all asked to stay at home and observe social distancing, the ability to exercise and follow a self-care rehabilitation intervention at home is never more pertinent. The REACH-HF programme has been shown to be a cost effective intervention (£1720 per quality adjusted life year [QALY]) that improves the quality of life of patients and helps them and their caregivers to self-manage. [2, 3]
Participation rates in centre-based cardiac rehabilitation programmes are suboptimal, despite current national and international recommendations. [4] Even before the outbreak of Covid-19 there were calls for new strategies to improve participation in cardiac rehabilitation, such as home- or web-based options. [4, 5]
The American College of Cardiology/American Heart Association has recently endorsed home-based rehabilitation [6] and the updated National Institute of Health and Care Excellence (NICE) 2018 guidance on chronic heart failure also states that ‘delivery of home-based rehabilitation may increase access and uptake’.[7]
Home-based programmes can also be delivered digitally and remotely. [8, 9] Internet based access reduces the need for face-to-face contact and an easily accessible platform for healthcare staff to facilitate delivery of rehabilitation programmes and interaction with patients and caregivers, without the need for travel. The British Heart Foundation has just awarded a grant to co-develop an internet based version of REACH HF.
The COVID-19 crisis is moving us in a direction where self-managed home-based interventions are being encouraged, and likely to remain with us, beyond the current pandemic. Research on the implementation of novel cardiac rehabilitation approaches is urgently needed to help guide changes in future cardiac rehabilitation services. We are keen to work with the NHS and key stakeholders to fast track access to REACH-HF to patients and their caregivers at this unprecedented time.
Authors: Hasnain Dalal [a,e] Rod Taylor [b] (co leads REACH-HF study group), Colin Greaves [c], Patrick Doherty [d], Sinead McDonagh [e], Sam van Beurden [e]; on behalf of the REACH-HF Study Group
(a)Royal Cornwall Hospitals NHS Trust, (b)University of Glasgow, (c)University of Birmingham, (d) University of York, (e)University of Exeter
References
[1] Wise J. The BMJ Awards 2020: Stroke and cardiovascular team of the year. BMJ ; 368:m844 doi: 10.1136/bmj.m844
[2] Dalal HM et al. 2018. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. European Journal of Preventive Cardiology, 26 (3), 262–272.
[3] Taylor RS et al. 2019. The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. Eur J Prev Cardiol. 26 (12), 1252-1261
[4] Dalal HM et al. 2015. Cardiac rehabilitation. BMJ, 351, h5000
[5] Lavie CJ et al. 2016. Cardiac Rehabilitation and Healthy Life-Style Interventions: Rectifying Program Deficiencies to Improve Patient Outcomes. Journal of the American College of Cardiology, 67, (1), 13–15
[6] Thomas RJ et al. Home- Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 2019;74: 133–53
[7] National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. NICE Guideline NG106. London: NICE; 2018
[8] Deighan C et al. 2017. The Digital Heart Manual: A pilot study of an innovative cardiac rehabilitation programme developed for and with users. Patient Educ Couns, 100 (8), 1598–1607
[9] Maddison R et al. 2019. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart, 105 (2), 122–129
Competing interests: No competing interests