1 Institute of Health Research, University of Exeter Medical School, Exeter, UK.
2 Royal Cornwall Hospitals NHS Trust, Truro, UK.
Eur J Prev Cardiol. 2019 Feb;26(3):262-272. doi: 10.1177/2047487318806358. Epub 2018 Oct 10.
Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low.
The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone.
The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of -5.7 points (95% confidence interval -10.6 to -0.7) in favour of the REACH-HF intervention group ( p = 0.025). With the exception of patient self-care ( p < 0.001) there was no significant difference in other secondary outcomes, including clinical events ( p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant.
The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.
心脏康复可改善心力衰竭患者的健康相关生活质量（HRQoL）并降低住院率，但国际上心力衰竭患者对心脏康复的接受程度仍然较低。
本多中心随机试验的目的是比较 REACH-HF（慢性心力衰竭中康复强化）干预措施，即一种促进自我护理和家庭为基础的心脏康复计划与心力衰竭射血分数降低（HFrEF）患者的常规护理。该研究的主要假设是，与单独常规护理相比，将 REACH-HF 干预措施添加到常规护理中可改善特定于疾病的 HRQoL（明尼苏达州心力衰竭生活质量问卷（MLHFQ））在 12 个月时。
该研究招募了 216 名参与者，主要是男性（78％），平均年龄为 70 岁，平均左心室射血分数为 34％。总体而言，185 名（86％）参与者提供了主要结局数据。在 12 个月时，REACH-HF 干预组的 MLHFQ 评分有显著的且具有临床意义的组间差异，差值为-5.7 分（95％置信区间-10.6 至-0.7），对 REACH-HF 干预组有利（p=0.025）。除了患者自我护理（p<0.001）之外，在其他次要结局（包括随访时的临床事件（p>0.05））方面与常规护理无显著差异。REACH-HF 干预的平均成本为每个参与者 418 英镑。
对于 HFrEF，新型的基于家庭的促进自我护理的 REACH-HF 干预在 12 个月时在特定于疾病的 HRQoL 方面具有临床优势，并且为解决当前心力衰竭患者心脏康复接受率低的问题提供了一种经济实惠的替代传统的基于中心的方案。
