A digital version of a programme which enables people living with heart failure to do their rehabilitation exercises at home has been conditionally recommended by NICE among a number that can now be used in the NHS.
D:REACH-HF is an online rehabilitation programme which patients can undertake at home with 12-weeks of facilitation from a health professional, co-developed with patients, caregivers and clinicians, it enables patients to learn more about and manage their own condition. Developed by a team led by the University of Exeter, it provides a secure web platform with education, self-monitoring of symptoms, structured at-home exercise, family and friends access for support, and a facilitator dashboard so healthcare professionals can tailor support remotely.
Cardiovascular disease affects more than 64 million people across the world, and prevalence is increasing, yet uptake of hospital-based cardiac rehabilitation programmes has been low - even though evidence shows they can work. In 2023, only 41 per cent of eligible people with acute coronary syndrome, which includes heart attack and angina, and 13 per cent of those with heart failure participated in cardiac rehabilitation programmes in England.
The original REACH-HF programme was shown to improve quality of life, yet until recently, it was paper-based. The new digital D:REACH-HF means wider access and more efficient personal tailoring of remote support without having to rely on patient recall particularly during telephone consultations.
Now, the National Institute for Health and Care Excellence has given permission for D:REACH-HF to be used in the NHS alongside six other programmes for three years, during which time more evidence will be collected on its long-term effectiveness.
Cardiac rehabilitation is a proven treatment that reduces the risk of further heart problems and hospital readmissions. Initially developed with funding from the National Institute for Health and Care Research the clinical trial found that taking part in REACH-HF significantly improved quality of life for patients. Initially paper-based (still provided by NHS Lothian), the new D:REACH-HF programme was converted to digital format with funding from the British Heart Foundation. It can now be accessed via any screen-based device that connects to the internet. Recently published research in 20 participants including patients, care-givers, and healthcare professionals found that the programme was rated highly, particularly for information credibility and functionality. Key benefits included flexibility in accessing the programme, structured self-monitoring, and healthcare professional support. Remote access to patient data enabled more efficient consultations, allowing healthcare professionals to focus on tailoring their support to patient needs. Challenges included technical issues, digital literacy, and engagement variability. All patients requested continued access to the platform, highlighting perceived long-term value.
The programme development has been led by the University of Exeter, with collaborators at the universities of Birmingham, Glasgow and York. The research involved engaging with patients, in work supported by the NIHR Applied Research Collaboration South West Peninsula (PenARC).
Samantha van Beurden, of the University of Exeter, said: "Working closely with patients, family members, and cardiac rehabilitation professionals, we've taken REACH-HF-the evidence-
based, home-based cardiac rehab programme for people with heart failure-and created D:REACH-HF: a digitally enhanced, NHS-ready version. Our study shows it's feasible and acceptable for supporting self-management and engagement in home-based CR, and we're delighted that NICE's Early Value Assessment supports NHS use while we continue to build the evidence on patient benefit"
Liz Clark patient representative on the REACH-HF projects, Devon and Cornwall Cardiac Commissioning Group, and several NICE committees, said of the programme:
"What I value about D:REACH-HF is that it brings personalised support into the home or from anywhere really, making rehabilitation more achievable at a time when motivation and confidence can be fragile. Having worked with the REACH-HF team for several years, I have seen the thoughtful co-design behind this programme, and I have high regard for NICE's careful evaluation process. I am pleased to see D:REACH-HF recognised in this assessment, as it will help more people access the support they need when they need it most."
The recent research paper is titled Digital adaptation of the clinically effective REACH-HF home-based cardiac rehabilitation programme for people living with heart failure (D:REACH-HF) and is published in Digital Health.
