Title: Extending the reach and implementation of the successful REACH-HF programme with a digitally delivered training programme.
Funder: Department of Health and Social Care

Abstract: Background: Heart failure affects almost 1 million adults in the UK and has a major impact on patient quality of life and NHS resources. The current proposal builds on a prior NIHR-funded research programme (RP-PG-1210-12004) which established the clinical effectiveness and cost-effectiveness of the REACH-HF home-based cardiac rehabilitation intervention for people with heart failure and their caregivers. To build on this success we now wish to scale up implementation to the national level, by training a large proportion of the existing (over 250) NHS CR centres in the UK to deliver REACH-HF. To support this, it is necessary to adapt the health professional training course for online /digital delivery. The face-to-face, three-day training used in our research programme is time-consuming and relatively expensive, so is not well suited for wide-scale implementation. Aims and Objectives: To develop a digitally delivered version of the training course for the REACH-HF home-based cardiac rehabilitation programme. We aim to test the feasibility and acceptability of the revised training and compare the resulting quality of delivery with benchmarks set in the REACH-HF trial. This will ensure that quality of intervention delivery can be maintained when moving to a less intensive training format. Development work plan: To develop the adapted training, we will apply the Person-Based Approach for digital intervention development in three stages: Firstly, working closely with groups of patients, caregivers and healthcare professionals, we will review the existing (face-to-face) REACH-HF training materials and examples of successful e-learning platforms. We will identify a way to structure the training content for delivery as an interactive, online training course, using &ldquo;wire-framing&rdquo; to map out the navigational flow and broad content. Secondly, we will use iterative cycles of qualitative research and stakeholder co-design workshops to try out and refine prototypes of the training materials. This will include think-aloud interviews, remote usability testing and a standardised usability questionnaire. Thirdly, we will deliver the online REACH-HF training course to 15 CR staff at five CR centres, who will each treat at least two (total 30-40) patients with heart failure. We will check quality of delivery using a fidelity checklist developed for our REACH-HF trial. This will be applied to audio-recordings of all provider-patient interactions. We will interview all CR staff about their experiences of being trained and delivering the intervention to identify any further training needs and will refine the training accordingly. Timelines for delivery: The project will last 22 months, including a 10 month development-and-optimisation stage, followed by a 14-month (with slight overlap for recruitment) feasibility-testing phase. Anticipated Impact and Dissemination: We envisage that the training course will be used to train 200 cardiac rehabilitation staff over the next five years, allowing REACH-HF to be delivered to approximately 20,000 people with heart failure per year. This will help to deliver the benefits of cardiac rehabilitation at a national scale to both patients with heart failure and the NHS and enable the translation of the NIHR-funded REACH-HF research programme into real-world practice in a cost-efficient and sustainable way.

Lay abstract: Background: Around 200,000 new cases of heart failure are identified each year. Heart failure can cause tiredness and a build-up of fluid in body tissues which can require emergency hospital care. Cardiac (heart) rehabilitation programmes support self-management of symptoms and exercise to rebuild fitness and heart health. There is strong evidence that cardiac rehabilitation improves quality of life and reduces hospital stays for heart failure patients. However, few individuals participate in rehabilitation due to difficulty travelling to rehabilitation clinics. In our previous NIHR-funded research programme, we developed and tested a home-based cardiac rehabilitation service, called &ldquo;REACH-HF&rdquo;. This 12-week programme (described further at https://reachhf.co.uk/) includes a choice of exercise programmes, a heart failure self-care manual, a progress tracker, a family and friends resource and support from health professionals. We showed that REACH-HF improves quality of life of heart failure patients and offers excellent value for money to the NHS. We now wish to promote the delivery of REACH-HF by cardiac rehabilitation teams across the UK. However, the current three-day, face-to-face REACH-HF training programme for NHS staff is time-consuming and costly. Offering online (internet-based) training would cost less and allow busy NHS staff to access the training when convenient to them. Aims: 1) To develop an online version of the REACH-HF cardiac rehabilitation staff training course. 2) To check, under controlled conditions, that the quality of delivery of REACH-HF, following online training for health professionals, is acceptable. Development and work plan: Working closely with heart failure patients, caregivers and cardiac rehabilitation staff, we will develop and test the acceptability of the online training. We will deliver the training to 15 staff who have not used REACH-HF before and they will then deliver REACH-HF to 30-40 heart failure patients. We will audio-record the delivery of REACH-HF to patients and, using a previously developed scoring tool, we will compare the delivery skills of trainees with standards set in the REACH-HF clinical trial. We will also interview the trainees about their experiences of delivering REACH-HF. Patient and public involvement: Up to 9 members of a Patient and Caregiver Advisory Group will review training ideas and ensure that it addresses patient and caregiver needs and concerns. Patients and caregivers will also help us to deliver the training via &ldquo;patient voice&rdquo; video clips. Dissemination and anticipated outcomes: Following the project, the NHS Lothian Heart Manual Department (a national provider of cardiac rehabilitation training) will deliver REACH-HF training across the UK. We will promote the training course via existing contacts, including the British Association of Cardiovascular Prevention and Rehabilitation. This project is a crucial step in scaling-up REACH-HF for national delivery. In turn, this will reduce hospital admissions improve the quality of life of heart failure patients.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR