Professor Janne Tolstrup is responsible for the project at the National Institute of Public Health, and Professor and Chief physician Ann-Dorthe Zwisler from department of Cardiology, Odense University Hospital and REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care has the clinical responsibility for the project.
Background
As a leading cause of morbidity and mortality and with high healthcare costs, heart failure (HF) places a large burden on patients, their families, and society. Participation in cardiac rehabilitation (CR) improves the health-related quality of life and reduces the risk of hospital admissions in people with HF and is a cost-effective intervention. CR is strongly recommended in international and Danish clinical guidelines for the management of HF.
However, our national register-based preliminary analysis shows that only one in two HF patients in Denmark are referred to CR. Moreover, it is well-known that a large proportion of cardiac patients referred to CR do not participate. Participation in CR is especially low among patients of lower education, who are living alone, and who have severe symptoms and comorbidity. CR provision has traditionally been centre-based but travelling (time and cost), dislike of group exercise, and inflexible and inconvenient timings, especially if working, are all potential barriers to participation. The COVID-19 pandemic reduced the provision and use of hospital-based CR services and underlined the need for alternative models of CR healthcare provision, including home and remote technology-based programmes. A novel evidence-based and award-winning home-based CR programme for patients with HF and their caregivers developed in the United Kingdom is Rehabilitation Enablement in Chronic Heart Failure (REACH-HF). REACH-HF is currently being implemented for patients across the UK National Health Service.
Purpose
The overarching aim of the DK:REACH-HF project is to increase the health-related quality of life in patients with HF by improving their access and uptake of CR in Denmark, particularly in subgroups of patients who do not typically participate in CR. It is hypothesised that the provision of the REACH-HF home-based intervention (as an alternative option to traditional centre-based programmes) will provide a cost-effective approach to improve the uptake of CR for people living with HF in Denmark, especially in the currently vulnerable ‘hard to reach’ subgroups. Such improvements in CR uptake can consequently strengthen patients’ well-being, increase quality of life, reduce hospitalisations and healthcare costs, and help reduce current social inequalities in health.
The specific objectives are to assess the current uptake of CR among HF patients in Denmark and identify low-participation groups, to adapt and digitalise the REACH-HF intervention to the Danish context – ‘DK:REACH-HF’ intervention, and to assess the feasibility and acceptability of the intervention.
Method
In this project we will (1) conduct a national register-based study among 35,000 HF patients to examine temporal trends, determinants, and outcomes of CR uptake in Denmark, (2) adapt and digitalise the REACH-HF intervention to the Danish context – ‘DK:REACH-HF’ intervention focusing on low-participation groups, and (3) conduct a 3-centre single-arm feasibility study among 75 patients (25 per site) and their caregivers with parallel process evaluation. We will employ various methods including surveys, interviews, and workshops. This is conducted in preparation for a national Danish multicentre randomized controlled trial.
Project period
February 2021 – August2023
Results will be published from ultimo 2021.
Collaboration and funding
We collaborate with Herning Municipality, City of Copenhagen, Svendborg Municipality, OUH Svendborg Hospital and the Regional Hospital Gødstrup.
The project is supported by an multidisciplinary advisory group consisting of 10 national and international experts:
- Rod Taylor, Professor Institute of Health and Well Being, University of Glasgow, UK (chair)
- Anne Nakano, Quality manager, The Danish Clinical Registries (RKKP), Aarhus, DK
- Charlotte Glümer, Head of center for diabetes in The City of Copenhagen, Copenhagen, DK
- Claus Vinther Nielsen, Professor, Chief physician, DEFACTUM, Regional Hospital West Jutland, Central Denmark Region and Institute of Public Health, Aarhus University, Aarhus, DK
- Elin Fredsted Petersen, President of SIG heart failure, specialist nurse, Department of Cardiology, Vejle Hospital.
- Hasnain Dalal, MD, Associate professor, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
- Karen la Cour, Professor, Department of Public Health, University of Southern Denmark, Odense, DK
- Kenneth Egstrup, Professor, Chief physician, Department of Cardiovascular Research, Odense University Hospital, Svendborg, DK
- Kirstine Lærum Sibilitz, Cardiology fellow, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DK
- Lars Kober, Professor, Chief physician Copenhagen University Hospital, Copenhagen, DK
- Teresa Holmberg, Associate professor, National Institute of Public Health, Copenhagen, DK