Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF)
REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) is a facilitated evidence based cardiac rehabilitation (CR) and self-management programme for use at home. It comprises the ‘heart failure manual’, a relaxation CD, a choice of exercise (walking programme or a chair-based DVD) a 'progress tracker' for patients, and a ‘family and friends resource’ for caregivers.
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Nearly 200,000 people are diagnosed with heart failure in the UK each year. Exercise-based rehabilitation, which is recommended by the National Institute for Health and Care Excellence (NICE), and self-care support are key to recovery, but many patients have difficulty in accessing centre-based rehabilitation services. 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 clinical services.
The REACH-HF programme was developed, with funding from the National Institute for Health Research (NIHR), by a collaboration involving several clinical and academic partners across the UK. This includes 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 collaboration has worked with patients and caregivers to produce a suite of resources, including self-care education, a choice of exercise programmes and psychological support.
The National Audit of Cardiac Rehabilitation (NACR) has observed an overall decrease in attendance to cardiac rehab, especially in patients with heart failure; numbers have fallen from 4969 (May 2019-Jan 2020) to 1474 (Feb 2020- Aug 2020). However, this has been associated with a substantial increase in the proportion of patients enrolling to home-based programmes from 22.2% to 72.4% in the same respective time frames.
The Wirral Community Cardiology Service, a REACH-HF beacon site, has adapted the delivery of REACH-HF during the pandemic allowing for patients and carergivers to engage in a rehabilitation programme while shielding in their own homes and observing the COVID-19 restrictions.
I thoroughly enjoyed the entire programme. Though my service is very limited in terms of a MDT (multi-disciplinary team) and quite fragmented - I can see how REACH-HF could/will be of huge benefit to patients.
Participant on REACH-HF online training course
How did the Innovation Exchange help?
REACH-HF received funding from the South West AHSN Innovation Adoption Fund COVID-19. The study team with NHS Lothian’s Heart Manual Department and Health and Care Innovations (HCI), played their part in supporting the NHS and heart failure patients by offering remote facilitator training. The monies were used to provide five, two-day REACH-HF online training courses (between May and September 2020) to nearly 90 health care professionals (cardiac nurses, physio/exercise therapists) to support vulnerable heart failure patients affected by restricted access to cardiac rehab during the pandemic. The online training was free-of-charge for all participants on the provision that they purchase 10 REACH-HF intervention packs/manuals (costing £30 each). Priority was given to participants from Cornwall & the Isles of Scilly, Devon and Somerset (South West AHSN catchment). They were also offered free REACH-HF manuals.
54 NHS organisations from across the UK, plus four centres from the Republic of Ireland, sent staff for training from the following locations: Abergavenny, Ayr, Basingstoke, Birkenhead (Wirral), Bristol, Cardiff, Chelmsford, Coventry, Crewe, Dartford, Dublin, Dundonald, Ebbw Vale, Exeter, Frimley, Glasgow, Harefield, Hengoed, Inverness, Kilmarnock, Kirkwall, Lancaster, Larbert, Leigh, Lerwick, Liskeard, Litherland, Liverpool, London, Londonderry, Manchester, Nenagh, Newport, Ormskirk, Pontypool, Sheffield, Shoreham-by-Sea, Southport, St Austell, St Martin, Stockport, Surbiton, Taunton, Truro, Warrington, Wick and Wishaw.
Healthcare professionals attending were mainly cardiac rehab and heart failure nurse specialists (48), physiotherapists and allied exercise professionals (30) with a few general nurses, a palliative care nurse and occupational therapists.
Nearly 20% (16) participants were from the South West as follows: Cornwall (12), Devon (3) and Somerset (1).
Impact & Outcomes
The South West AHSN Innovation Adoption Fund COVID-19 enabled the REACH-HF team to provide training to nearly 90 health care professionals in the summer of 2020. NHS Lothian has now taken on the REACH-HF online training to the end of 2021 having trained another 14 nurses/physios in November 2020. See here for more information.
Potentially, in the next year, over 1000 patients with heart failure could benefit from evidence-based rehab in the comfort of their own homes at a pertinent time, i.e. when vulnerable people are asked to shield from COVID-19.
In October 2020, REACH-HF won the prestigious BMJ 2020 ‘Stroke and Cardiovascular Care Team of the Year’ Award
NICE has now included REACH-HF on their shared learning database