Protocol for an implementation study of an evidence-based home cardiac rehabilitation programme for people with heart failure and their caregivers in Scotland (SCOT:REACH-HF)

Abstract

IntroductionDespite evidence that cardiac rehabilitation (CR) is an essential component of care for people with heart failure, uptake is low. A centre-based format is a known barrier, suggesting that home-based programmes might improve accessibility. The aim of SCOT: Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is to assess the implementation of the REACH-HF home-based CR intervention in the context of the National Health Service (NHS) in Scotland.This paper presents the design and protocol for this observational implementation study. Specific objectives of SCOT:REACH-HF are to: (1) assess service-level facilitators and barriers to the implementation of REACH-HF; (2) compare real-world patient and caregiver outcomes to those seen in a prior clinical trial; and (3) estimate the economic (health and social) impact of implementing REACH-HF in Scotland.Methods and analysisThe REACH-HF intervention will be delivered in partnership with four ‘Beacon sites’ across six NHS Scotland Health Boards, covering rural and urban areas. Health professionals from each site will be trained to facilitate delivery of the 12-week programme to 140 people with heart failure and their caregivers. Patient and caregiver outcomes will be assessed at baseline and 4-month follow-up. Assessments include the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-dimension EuroQol 5L, Hospital Anxiety and Depression Scale, and the Caregiver Burden Questionnaire. Qualitative interviews will be conducted with up to 20 health professionals involved in programme delivery (eg, cardiac nurses, physiotherapists). 65 facilitator-patient consultations will be audio recorded and assessed for fidelity. Integrative analysis will address key research questions on fidelity, context and CR participant-related outcomes. The SCOT:REACH-HF findings will inform the future potential roll-out of REACH-HF in Scotland.Ethics and disseminationThe study has been given ethical approval by the West of Scotland Research Ethics Service (reference 20/WS/0038, approved 25 March 2020). Written informed consent will be obtained from all participants. The study is listed on the ISRCTN registry with study ID ISRCTN53784122. The research team will ensure that the study is conducted in accordance with both General Data Protection Regulations and the University of Glasgow’s Research Governance Framework. Findings will be reported to the funder and shared with Beacon Sites, to facilitate service evaluation, planning and good practice. To broaden interest in, and understanding of REACH-HF, we will seek to publish in peer-reviewed scientific journals and present at stakeholder events, national and international conferences.

L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic

“…When comparing patients according to the number of attended sessions (<24 sessions vs. ≥25 sessions), at 1-year and 5-year, mortality rates were shown to be significantly lower for those who attended ≥25 CR sessions (2.2% vs. 5.3% at 1-year, and 16.3% vs. 24.6% at 5-years) (Suaya et al, 2009). To overcome this issue, other CR formats have been proposed and are currently being examined (Jin et al, 2014;Abell et al, 2016;Pio et al, 2019;Abreu et al, 2020;Purcell et al, 2020;Forman et al, 2022). Home-based CR programs may improve both participation and outcomes, especially for patients who are living far from standard supervised programs (Besnier et al, 2021;Vonk et al, 2021;Terbraak et al, 2022).…”

The role of cardiac rehabilitation in improving cardiovascular outcomes

“…Subsequent economic modelling on the basis of the results from the trial confirmed the acceptable cost-effectiveness of the REACH-HF programme, with an ICER of £1,720 per QALY 48 . Given its clinical effectiveness and cost-effectiveness, the REACH-HF programme is now being rolled out into routine care across the UK and the Republic of Ireland to improve access to and uptake of cardiac rehabilitation 49,50 .…”

Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)

“…We employed a mixed-method, single arm, pre-post design, collecting both quantitative and qualitative data, and drawing on UK Medical Research Council (MRC) guidance on evaluation of complex interventions. 14,15 CR services in six (of a total of 14) NHS Scotland regional Health Boards were included as early adopter sites: NHS Ayrshire and Arran; NHS Lanarkshire; NHS Forth Valley; and NHS Highland, Orkney, and Shetland (the latter three were combined due to small patient numbers). NHS Greater Glasgow and Clyde sponsored the study, and the West of Scotland Research Ethics Service (20/WS/0038) gave ethical approval.…”