The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial
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- Hasnain M Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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- Russell C Davis
- Cardiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
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- Patrick Doherty
- Department of Health Sciences, University of York, York, UK
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- Jackie Miles
- Research and Development, Aneurin Bevan University Health Board, St Woolos Hospital, Newport, UK
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- Robin van Lingen
- Duchy Hospital, Truro, UK
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- Fiona C Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Colin Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Jennifer Wingham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Colin Greaves
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Susannah Sadler
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Melvyn Hillsdon
- Sport and Health Sciences, University of Exeter, Exeter, UK
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- Charles Abraham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Nicky Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Julia Frost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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- Sally Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
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- Christopher Hayward
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
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- Victoria Eyre
- Re:Cognition Health, London, UK
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- Kevin Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
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- Chim C Lang
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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- Karen Smith
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
説明
<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design and methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>
収録刊行物
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- European Journal of Preventive Cardiology
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European Journal of Preventive Cardiology 26 (3), 262-272, 2018-10-10
Oxford University Press (OUP)