Home-based rehabilitation improves quality of life in chronic HFrEF
For patients with HF with reduced ejection fraction, adding a home-based cardiac rehabilitation intervention to usual care may improve disease-specific health-related quality of life and aid with self-management, according to a study published in the European Journal of Preventive Cardiology.
“Although previous hospital-based studies have shown an improvement in quality of life and reduction in hospital admissions for patients receiving cardiac rehabilitation, heart failure patients often find it difficult to attend rehabilitation centers in hospitals,” Hasnain M. Dalal, MD, of the Institute of Health Research at the University of Exeter Medical School and the Royal Cornwall Hospitals NHS Trust, both in the United Kingdom, said in a press release. “This tends to be due to lack of access to transport, poor mobility, and other health problems and can lead to isolation and depression. Our research gives us hope that this more accessible rehabilitation intervention will increase participation and improve patients’ quality of life.”
For the REACH-HF multicenter randomized controlled trial, researchers recruited 216 adults with HFrEF from primary and secondary care settings in the United Kingdom (mean age, 70 years; 78% men; mean left ventricular ejection fraction, 34%).
Between 2015 and February 2016, researchers assigned 109 participants to usual care, which consisted of medical management with specialist HF nurse care but no cardiac rehabilitation, and 107 participants to the REACH-HF intervention. The home-based intervention consisted of a program with an exercise manual (structured chair-based exercise or walking training), a progress tracker (booklet in which patients recorded plans for walking, whether they did it, effort level and walking pace), a family and friends resource (manual for caregivers to increase understanding of HF) and facilitation by cardiac nurses or physiotherapists.
Quality of life improved
The primary outcome was disease-specific health-related quality of life, which was measured with the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Secondary outcomes included death, hospitalization, generic quality of life, psychological well-being, exercise capacity and physical activity.
Data were collected at clinic visits at baseline, 4 months and 12 months.
Researchers found that, at 12 months, MLHFQ total scores did not change for usual care but improved in the REACH-HF group, with a –5.7 between-group point difference (95% CI, –10.6 to –0.7).
REACH-HF participants also had improved MLHFQ physical scores (mean difference between groups at 12 months, –3.2; 95% CI, –5.7 to –0.6).
In addition, participants in the REACH-HF group had better maintenance scores on the Self-Care of Heart Failure Index (P < .001). No significant differences in other secondary outcomes were observed, according to the researchers.
After conducting a post hoc analysis, researchers found that 52% of participants in the REACH-HF group and 33% of participants in usual care achieved a reduction of at least 5 MLHFQ points.
The mean total cost for delivery of the REACH-HF intervention was estimated at 418.39 British pounds per participant, which makes the program affordable, according to the researchers.
“The results of this study provide compelling evidence that a home-based program of exercise and self-care support for people with heart failure and their caregivers should now be rolled out as part of national NHS policy,” Colin Greaves, DPhil, FRSC, of the school of chemistry at the University of Birmingham, U.K., said in the release. – by Melissa J. Webb
Disclosures: The authors report receiving grants from the U.K. National Institute for Health Research.