University of Exeter: Exeter-led team receives national funding to roll-out innovative rehab programme
Taking up rehabilitation after experiencing heart failure improves quality of life, and can be lifesaving, yet programmes delivered in-person in health centres are often poorly attended. REACH HF is a comprehensive programme giving people with heart failure an alternative to receiving rehabilitation in a hospital clinic. It includes an exercise, psychological support and education programme that can be conducted from the comfort of the individual’s home.
Research, originally funded by National Institute for Health Research (NIHR), showed that REACH HF was not only clinically effective in improving health related quality of life but also cost effective. The home-based rehabilitation programme proved particularly valuable at the height of the COVID-19 pandemic, where many older and vulnerable people shielding at home were unable to attend hospital. The REACH-HF team’s moves to ensure the programme was adapted for delivery during COVID-19 was one of the factors that won them the BMJ Stroke and Cardiovascular team of the year award in in 2020. A recent review published in Nature authored by members of the REACH HF team report that an increasing body of evidence supports home models of rehabilitation as a successful alternative to traditional centre-based programmes.
Following the success of the multicentre trial, the programme is being evaluated as part of routine clinical practice in eight NHS cardiac rehabilitation centres in England, Scotland and Northern Ireland. This ongoing evaluation is showing that REACH HF can be effectively delivered across different ‘real world’ healthcare settings.
Now, NHS England is providing funding to train 60 health care professionals in up to 20 sitesacrossEngland in 2021-22. The two-day training programme (hosted by the Heart Manual Department, NHS Lothian) will take place online, and health trusts are encouraged to apply early, with priority given to areas where the uptake of cardiac rehabilitation is currently the lowest based on the latest data from the National Audit of Cardiac Rehabilitation (NACR).
Associate Professor Hasnain Dalal, of the University of Exeter and the Royal Cornwall Hospitals NHS Trust (RCHT), said: “Our home-based cardiac rehabilitation programme for people with heart failure and their caregivers is designed to improve take-up of this service that is so important to improving lives, by making it much easier for often elderly, vulnerable people to access – by bringing it into their homes. Over the past few years, we’ve built up a strong evidence base that it works – I’m delighted to see this being rolled out to benefit those who need it, and I’d encourage health trusts to come forward and take advantage of this free training.”
The REACH-HF programme has benefitted patients and has been well received by health practitioners. One patient told the team: “I appreciate that COVID-19 has changed everything, but until I received this pack, I was scared, clueless and frightened. This pack and the support I received on the phone were a life-saver, and I cannot thank them enough. In that moment, everything fell into place and I reclaimed my life.”
Another patient said: “I still use the heart failure manual as a reference tool several years after I was involved in the trial. It is a mine of information and saves me having to go to my GP or heart failure nurse in the first instance.”
Caroline Golder, Lead Nurse at Wirral Community Cardiology Service and Wirral Community Health and Care NHS Foundation Trust, said “REACH HF has enriched our cardiac rehab service immensely. It has enabled our team to provide cardiac rehab to a group of patients who would not have been able to access our service in the past. It has been an invaluable resource during the pandemic, and we have received nothing but positive feedback from patients who have felt the benefit from the REACH HF programme. It has enabled them to remain active in their homes during a very turbulent time.”
The REACH-HF programme was developed by a collaboration involving several clinical and academic partners across the UK including the Universities of Birmingham, Dundee, Exeter, Glasgow, Plymouth and York together with the Aneurin Bevan University Health Board, NHS Lothian, Ninewells Hospital & Medical School, Dundee, Royal Cornwall Hospitals NHS Trust, Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals of Leicester NHS Trust and York Hospitals NHS Foundation Trust. The REACH-HF collaboration has received research and implementation funding past and present from a number of research funders and charities including: the National Institute for Health Research (NIHR), the British Heart Foundation (BHF), Heart Research UK, and the Southwest Academic Health Sciences Network
Professor Nick Linker, NHS national clinical director for heart disease said: “The NHS Long Term Plan sets out our ambition to increase the number of patients accessing cardiac rehabilitation by scaling up services and ensuring those who are eligible are aware of the support on offer. This funding is focused on doing just that and will ensure heart failure patients benefit from the additional at home support that they might need.”