Summary of the REACH-HF intervention description according to the Template for Intervention Description and Replication15
| Brief name | Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) |
| Why | The rationale for REACH-HF was to provide a home-based rehabilitation comprehensive self-care support programme to people with heart failure and their caregivers to help them manage their condition (https://sites.exeter.ac.uk/reachhf/). It was co-created with people living with heart failure (HF) and their families, as well as service providers using an established rigorous intervention development framework to incorporate existing evidence, clinical guidance on HF self-care, behaviour change theory and key stakeholder perspectives (patients, caregivers, service providers and experts in the field).14 REACH-HF draws on several theoretical perspectives, but key principles included building understanding of the condition to provide a rationale for change (Leventhal’s common-sense model47) such as how physical fitness affects heart failure symptoms; building intrinsic motivation and promoting autonomy (self-determination theory48); promoting adaptation to living with heart failure and adopting an active rather than passive approach to coping49 50; and encouraging learning from experience through engagement in self-regulation activities (control theory51). The elements aimed at managing stress and anxiety used psychological intervention processes based on cognitive–behavioural therapy52 and mindfulness therapy53 54. |
| What – materials | The REACH-HF intervention includes four core elements:
The REACH-HF programme was originally designed for patients with HFrEF. However, sections of the manual (including the medication section) have been revised to make it relevant to patients with HFpEF, and an additional section on the nature of causes and treatment of HFpEF has been added. |
| What – procedures | Patients and caregivers work through the self-help manual over a 12-week period with facilitation involving contact by a specially trained intervention facilitator who will help to assess patient needs and concerns, build the patient’s and caregiver’s understanding of how best to manage HFpEF and provide individually tailored support based on each patient’s identified needs and concerns. |
| Who provided | REACH-HFpEF trial funding is provided for two/three healthcare professionals with experience of cardiac rehabilitation/heart failure: cardiac rehabilitation nurse, physiotherapist or exercise specialist or HF specialist nurse) from each site, who are responsible for delivering the REACH-HF intervention, and will attend a 2-day web-based training course on the use of person-centred counselling and how to tailor the intervention for the patient and their caregiver, led by clinicians in the Heart Manual Department, NHS Lothian (https://services.nhslothian.scot/theheartmanual/reachhf/). Topics covered in training include: self-management in HF; psychological aspects of HF; health behaviour change; supporting family and caregivers; physical activity and chair-based exercise. |
| How | The programme has been designed to be delivered over 12 weeks, with a recommended two face-to-face contacts with a REACH-HF facilitator taking place in the patient home and 2–3 follow-up telephone contacts in between. ‘Real world’ programme implementation, especially during the COVID-19 pandemic, has resulted in alternative modes of delivery. These have included: combined centre-based and home-based delivery (eg, baseline and end-of-treatment assessments conducted in clinics, with home visits and/or phone support in between) and an entirely remote delivery model, where all sessions (including assessments) were conducted by telephone. |
| Where | Patient home and/or clinic. |
| When and how much | Initial face-to-face session: 60–90 min—initial clinical consultation, facilitator discusses programme and introduces patient/caregiver to the REACH-HF resources. Telephone consultations: 2–3 (dependent on patient needs) of~10 mins—check on progress with HF manual and exercise programme. Final face-to-face session: 60–90 min—final clinical consultation, review of goals and plan for continuing REACH-HF programme independently |
| Tailoring | While the principles of the REACH-HF intervention are the same across HF patients, facilitators are trained to tailor intervention delivery to individual patient needs, for example, adjust exercise level to current fitness. |
HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection.