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As the winners of the BMJ Award in the Stroke and Cardiovascular category, the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) team is delighted with the prestigious accolade and recognition. [1] We are particularly pleased to see our intervention making an early impact on service delivery in the UK.
Since the first UK COVID-19 lockdown restrictions in March 2020, many parts of the NHS have reported depletion in the provision and use of services. Significant numbers of patients have not been able to access care in hospitals, thus missing out on appropriate treatment and support. [2]
A recent report from the British Heart Foundation (BHF) has highlighted how the pandemic has exacerbated the ‘disjointed and unequal care and support... for the 920,000 people living with heart failure and the 200,000 diagnosed each year’ saying that ‘we can do better’. [2]
The National Audit for Cardiac Rehabilitation (NACR) has observed a fall in the number of patients with heart failure participating in rehabilitation from 4,969 (< 10 % of eligible patients) in the pre- pandemic period (May 2019 to January 2020) to 1,474 (< 5 % of eligible patients) in February to August 2020. Although the overall uptake of rehabilitation has got worse, services have responded by offering home-based and remote options of delivery. NACR Covid-19 service change analysis, presented at the 2020 BACPR Conference, showed that the proportion receiving home based delivery has increased more than threefold –from 22.2% pre- to 72.4% post-Covid-19. [3]
The REACH-HF programme, a home-based cardiac rehabilitation programme facilitated by healthcare professionals (http://thebmjawards.bmj.com/showcase/), has been successfully adopted by the Wirral Community Cardiology service, one of the first REACH-HF beacon Sites. Earlier this year, the Wirral team made adaptations to the delivery of REACH-HF so that the nurses and exercise physiologists could continue to provide the intervention to heart failure patients remotely, in line with COVID-19 restrictions. To date, the Wirral team have delivered REACH-HF to 100 patients with heart failure – with nearly 70 % of patients participating in REACH-HF since the initial lockdown in March 2020. The intervention has been well received by patients and staff, especially as they are continuing to offer rehabilitation to their vulnerable patients throughout the second wave of the pandemic.
The BHF commends ‘innovations in service delivery such as the REACH-HF facilitated home-based rehabilitation’ as ‘there is potential to improve the number of heart failure patients accessing services’. They have recently funded the development of a digital version of REACH-HF which will improve access to rehabilitation during, and beyond, the pandemic. [2]
Home-based cardiac rehabilitation options are also gaining favour in the USA in response to COVID-19 with the Centers for Medicare and Medicaid Services introducing reimbursements for virtual cardiac rehabilitation for the first time, from October 2020. [4]
Winning the BMJ Award should help to leverage support from commissioners and policy makers to widen the roll-out of REACH–HF, thus increasing the uptake of rehabilitation in heart failure, which is a priority set out in the NHS Long Term Plan.[2]
Hasnain M Dalal, Rod S Taylor (co leads REACH-HF study group, Royal Cornwall Hospital NHS Trust and University of Glasgow), Colin J Greaves (University of Birmingham), Patrick Doherty (University of York), Sinead McDonagh (University of Exeter), Samantha B van Beurden (University of Exeter); on behalf of the REACH HF Study Group
[1] Limb M. The BMJ Awards 2020: showcase of this year’s winning teams https://www.bmj.com/content/bmj/371/bmj.m4341.full.pdf (Published 11 November 2020)
[2] British Heart Foundation (2000) Heart Failure: a blueprint for change. https://www.bhf.org.uk/blueprint
[3] BACPR Conference 2020 www.bacpr.com
[4] Vishwanath V, Beckman AL, Kazi DS. Reimagining Cardiac Rehabilitation in the Era of Coronavirus Disease 2019. JAMA Health Forum. Published online November 4, 2020. doi:10.1001/jamahealthforum.2020.1346
Competing interests:
No competing interests
13 November 2020
Hasnain M Dalal
Associate Professor, University of Exeter
Hasnain M Dalal, Rod S Taylor (co leads REACH-HF study group, University of Exeter and University of Glasgow), Colin J Greaves (University of Birmingham), Patrick Doherty (University of York), Sinead McDonagh (University of Exeter), Samantha B van Beurden (University of Exeter); on behalf of the REACH HF Study Group
University of Exeter Medical School
Knowledge Spa, Royal Cornwall Hospital NHS Trust, Truro, TR1 3 HD
BMJ Award winner making early impact on service delivery
Dear Editor
As the winners of the BMJ Award in the Stroke and Cardiovascular category, the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) team is delighted with the prestigious accolade and recognition. [1] We are particularly pleased to see our intervention making an early impact on service delivery in the UK.
Since the first UK COVID-19 lockdown restrictions in March 2020, many parts of the NHS have reported depletion in the provision and use of services. Significant numbers of patients have not been able to access care in hospitals, thus missing out on appropriate treatment and support. [2]
A recent report from the British Heart Foundation (BHF) has highlighted how the pandemic has exacerbated the ‘disjointed and unequal care and support... for the 920,000 people living with heart failure and the 200,000 diagnosed each year’ saying that ‘we can do better’. [2]
The National Audit for Cardiac Rehabilitation (NACR) has observed a fall in the number of patients with heart failure participating in rehabilitation from 4,969 (< 10 % of eligible patients) in the pre- pandemic period (May 2019 to January 2020) to 1,474 (< 5 % of eligible patients) in February to August 2020. Although the overall uptake of rehabilitation has got worse, services have responded by offering home-based and remote options of delivery. NACR Covid-19 service change analysis, presented at the 2020 BACPR Conference, showed that the proportion receiving home based delivery has increased more than threefold –from 22.2% pre- to 72.4% post-Covid-19. [3]
The REACH-HF programme, a home-based cardiac rehabilitation programme facilitated by healthcare professionals (http://thebmjawards.bmj.com/showcase/), has been successfully adopted by the Wirral Community Cardiology service, one of the first REACH-HF beacon Sites. Earlier this year, the Wirral team made adaptations to the delivery of REACH-HF so that the nurses and exercise physiologists could continue to provide the intervention to heart failure patients remotely, in line with COVID-19 restrictions. To date, the Wirral team have delivered REACH-HF to 100 patients with heart failure – with nearly 70 % of patients participating in REACH-HF since the initial lockdown in March 2020. The intervention has been well received by patients and staff, especially as they are continuing to offer rehabilitation to their vulnerable patients throughout the second wave of the pandemic.
The BHF commends ‘innovations in service delivery such as the REACH-HF facilitated home-based rehabilitation’ as ‘there is potential to improve the number of heart failure patients accessing services’. They have recently funded the development of a digital version of REACH-HF which will improve access to rehabilitation during, and beyond, the pandemic. [2]
Home-based cardiac rehabilitation options are also gaining favour in the USA in response to COVID-19 with the Centers for Medicare and Medicaid Services introducing reimbursements for virtual cardiac rehabilitation for the first time, from October 2020. [4]
Winning the BMJ Award should help to leverage support from commissioners and policy makers to widen the roll-out of REACH–HF, thus increasing the uptake of rehabilitation in heart failure, which is a priority set out in the NHS Long Term Plan.[2]
Hasnain M Dalal, Rod S Taylor (co leads REACH-HF study group, Royal Cornwall Hospital NHS Trust and University of Glasgow), Colin J Greaves (University of Birmingham), Patrick Doherty (University of York), Sinead McDonagh (University of Exeter), Samantha B van Beurden (University of Exeter); on behalf of the REACH HF Study Group
[1] Limb M. The BMJ Awards 2020: showcase of this year’s winning teams https://www.bmj.com/content/bmj/371/bmj.m4341.full.pdf (Published 11 November 2020)
[2] British Heart Foundation (2000) Heart Failure: a blueprint for change. https://www.bhf.org.uk/blueprint
[3] BACPR Conference 2020 www.bacpr.com
[4] Vishwanath V, Beckman AL, Kazi DS. Reimagining Cardiac Rehabilitation in the Era of Coronavirus Disease 2019. JAMA Health Forum. Published online November 4, 2020. doi:10.1001/jamahealthforum.2020.1346
Competing interests: No competing interests