REACH-HF - is an award winning cardiac rehabilitation programme which helps people living with heart failure improve their quality of life from the comfort and safety of their own homes - is being rolled out in six NHS Scotland Health Boards from this month.
The new research study, SCOT:REACH-HF, will be led by University of Glasgow researchers in collaboration with NHS Scotland clinicians. Funded by the Heart Research UK charity, SCOT:REACH-HF will help researchers understand how the rehabilitation programme performs in ’real world’ Scottish NHS settings.
Around one million people in the UK have heart failure. Having the condition means that the heart is unable to function efficiently, causing debilitating symptoms such as fatigue, shortness of breath, and a dangerous accumulation of fluid. Heart failure can have a negative impact on a person’s quality of life, and often results in unplanned hospital admissions.
Currently, heart failure costs the NHS approximately £2 billion per year, largely as a result of unplanned hospitalisations. Cardiac rehabilitation is an effective therapy; however, only one in 20 people with a diagnosis of heart failure currently receive rehabilitation. A key barrier to participation is the challenge for people with heart failure of being able to travel to hospital to take part in classes or group sessions.
The research team believe that the roll out of REACH-HF is timely in the context of the current Covid-19 pandemic. Where NHS services are under pressure, people with underlying chronic conditions (such as heart failure) have at times been asked to shield, and there are risks associated with providing hospital-based rehabilitation. REACH-HF may offer a crucial alternative to support people with heart failure and their families to self-manage their care at home.
The 12-week programme includes: chair-based exercises that can easily be done at home; a walking plan; audio with relaxation techniques; and a manual with advice on lifestyle and medication. Also included is an interactive booklet designed to facilitate learning from experience, and record symptoms, physical activity and other aspects of self-care. A ’friends and family’ manual aims to support those who provide care and improve their understanding of the condition. The programme is facilitated by healthcare professionals through telephone or web-based consultation. Facilitator training and REACH-HF materials are provided for the study in collaboration with the wider REACH-HF team (based in the Universities of Exeter, Birmingham, and York) and the Heart Manual Department in NHS Lothian.
The Rehabilitation Enablement in CHronic Heart Failure (REACH-HF) programme, was originally developed by a collaboration led by Professor Rod Taylor (University of Glasgow) and Dr Hasnain Dalal (University of Exeter and the Royal Cornwall Hospitals NHS Trust), and a UK-based team of researchers. Their large-scale trial in England and Wales has already found that REACH-HF can significantly improve quality of life of patients, and that it can be cost-effective for the NHS to deliver.
The SCOT:REACH-HF study aims to recruit 140 people with heart failure, along with a partner, family member, or friend who helps them to manage their condition. Six NHS Scotland Health Boards have been selected to act as ’beacon’ sites, to provide what will hopefully be the first wave of REACH-HF roll-out across Scotland. The Scottish beacon sites are NHS Ayrshire and Arran, Forth Valley, Lanarkshire, Highland, Orkney, and Shetland. Sites were chosen for geographical spread (covering rural and urban populations), and their commitment to offering home-based heart failure care. The REACH-HF team is also the BMJ Cardiovascular and Stroke team of the year 2020.
Prof Taylor, Dr Carrie Purcell and Dr Tracy Ibbotson, of the University of Glasgow, will conduct the research study to monitor programme delivery at each site, allowing for evaluation and refinement before provision might be further extended across Scotland.
Professor Rod Taylor, Professor of Population Health Research at the University of Glasgow, said: "Rehabilitation is key element of care to help people with heart failure live their lives as well as possible. We know from our clinical trials that REACH-HF can improve patient quality of life and that it is cost-effective. The SCOT:REACH-HF study seeks to determine if the programme can be implemented within the real world of the Scottish NHS. As a home-based programme with remote support by healthcare professionals, REACH-HF also overcomes many of the obstacles that often stop people with heart failure attending hospital-based programmes, especially during COVID-19."
Dr. ClareMurphy SCOR-REACH-HF coapplicant and, Consultant Physician and Cardiologist and clinical lead of Scottish Heart Failure Network, said: "Rehabilitation has been proven to improve quality of life, a top priority, for people living with heart failure. However, providing parity of access to these programmes for people living with heart failure continues to be a challenge for UK NHS services.
SCOT: REACH-HF will provide an exciting opportunity to overcome some of the access barriers to rehabilitation for people living with heart failure in Scotland, by delivering an individually tailored home-based rather than healthcare facility based programme, that is supported by clinical trial evidence for its benefit."
Lynn Laidlaw, who has experienced cardiac rehabilitation and is a member of the public and patient involvement group for the University of Glasgow, and lives in the Forth Valley area, said: "My experience of cardiac rehab was overwhelmingly positive. Living with heart disease is scary, I was afraid to push myself when exercising for fear of making my symptoms worse. The rehab team supported me to face up to my fears and helped me reclaim the part of me that really enjoyed exercise, in a safe, appropriate way. Lockdown has made it challenging for those of us living with heart disease to access services, this programme is great and very timely. "
Helen Wilson, Head of Research at Heart Research UK, said: "It is estimated that heart failure affects almost a million people in the UK and clearly, there is a need to improve the way we care for people with this condition. This home-based programme is particularly important and timely during the Covid-19 pandemic, and will help patients to access cardiac rehabilitation.
"Heart Research UK is committed to funding cutting edge research that benefits patients as soon as possible. REACH-HF has the potential to improve the quality of life of heart failure patients, whilst easing the strain on our NHS and hopefully delivering tangible and speedy results. We are incredibly proud to be supporting such vital work."