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Cardiovascular medicine
Protocol
Protocol for an implementation study of an evidence-based home cardiac rehabilitation programme for people with heart failure and their caregivers in Scotland (SCOT:REACH-HF)
  1. Carrie Purcell1,
  2. Paulina Daw2,
  3. Claire Kerr3,
  4. J Cleland3,
  5. Aynsley Cowie4,
  6. Hasnain M Dalal5,6,
  7. Tracy Ibbotson7,
  8. Clare Murphy8,
  9. Rod Taylor9
  1. 1MRC/CSO SPHSU, University of Glasgow, Glasgow, UK
  2. 2School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  3. 3Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  4. 4Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
  5. 5Royal Cornwall Hospitals NHS Trust, Truro, UK
  6. 6College of Medicine and Health, University of Exeter Medical School, Exeter, UK
  7. 7Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  8. 8Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
  9. 9MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Carrie Purcell; Carrie.Purcell{at}glasgow.ac.uk

Abstract

Introduction Despite evidence that cardiac rehabilitation (CR) is an essential component of care for people with heart failure, uptake is low. A centre-based format is a known barrier, suggesting that home-based programmes might improve accessibility. The aim of SCOT: Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is to assess the implementation of the REACH-HF home-based CR intervention in the context of the National Health Service (NHS) in Scotland.

This paper presents the design and protocol for this observational implementation study. Specific objectives of SCOT:REACH-HF are to: (1) assess service-level facilitators and barriers to the implementation of REACH-HF; (2) compare real-world patient and caregiver outcomes to those seen in a prior clinical trial; and (3) estimate the economic (health and social) impact of implementing REACH-HF in Scotland.

Methods and analysis The REACH-HF intervention will be delivered in partnership with four ‘Beacon sites’ across six NHS Scotland Health Boards, covering rural and urban areas. Health professionals from each site will be trained to facilitate delivery of the 12-week programme to 140 people with heart failure and their caregivers. Patient and caregiver outcomes will be assessed at baseline and 4-month follow-up. Assessments include the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-dimension EuroQol 5L, Hospital Anxiety and Depression Scale, and the Caregiver Burden Questionnaire. Qualitative interviews will be conducted with up to 20 health professionals involved in programme delivery (eg, cardiac nurses, physiotherapists). 65 facilitator-patient consultations will be audio recorded and assessed for fidelity. Integrative analysis will address key research questions on fidelity, context and CR participant-related outcomes. The SCOT:REACH-HF findings will inform the future potential roll-out of REACH-HF in Scotland.

Ethics and dissemination The study has been given ethical approval by the West of Scotland Research Ethics Service (reference 20/WS/0038, approved 25 March 2020). Written informed consent will be obtained from all participants. The study is listed on the ISRCTN registry with study ID ISRCTN53784122. The research team will ensure that the study is conducted in accordance with both General Data Protection Regulations and the University of Glasgow’s Research Governance Framework. Findings will be reported to the funder and shared with Beacon Sites, to facilitate service evaluation, planning and good practice. To broaden interest in, and understanding of REACH-HF, we will seek to publish in peer-reviewed scientific journals and present at stakeholder events, national and international conferences.

  • cardiology
  • rehabilitation medicine
  • heart failure
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2020-040771

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    Footnotes

    • Twitter @DrCarrieP

    • Contributors The study was conceived of and designed by RT, HD and the REACH-HF collaboration. CP and RT drafted the manuscript. RT and CP will lead recruitment and set-up of Beacon Sites, and CP will oversee day-to-day project management. RT, CK and CP secured all relevant ethical approvals for the project and prepared all study documentation, to which PD also contributed. AC designed the PROM-CR measure. CP and RT will conduct study analysis and write-up. TI will lead on coordinating PPI. JC and CM will provide project supervision and oversight. All authors reviewed and approved the final version of this protocol for publication.

    • Funding This work is supported by Heart Research UK (grant SC09/19) and conducted by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (grants SPHSU14 and MC_UU_12017/14). RT is part funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research scheme (project reference RP-PG-1210-12004).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.