The REACT-CHF Study - Early Rehabilitation after hospitalisation for an acute exacerbation of chronic heart failure: a randomised controlled trial

Principal Investigator: Ms Linzy Houchen

Other key staff: Professor Sally Singh, Dr Ian Loke, Sally Boyce, Dr Mick Steiner, Professor Mike Morgan, Dr John Bankart and Dr Rachael Evans.

Partners involved: University Hospitals of Leicester NHS Trust

Summary: One of the characteristic features of Chronic Heart Failure (CHF) is the longitudinal decline in physical activity (PA) which leads to physical deconditioning, skeletal muscle dysfunction and worsening exercise tolerance. People with CHF experience acute exacerbations (AE) of their symptoms, also known as episodes of ‘acute decompensation’. These episodes have detrimental effects in terms of decreased muscle strength, decreased PA and often require a hospital admission which is a huge burden to the individual and the National Health Service.

Rehabilitation for stable CHF patients is well established and has been proven to increase exercise tolerance and quality of life. However the effects of rehabilitation immediately after an AE are unknown.

This study involves 62 participants in total and compares early rehabilitation (intervention) compared to ‘best usual care’. The rehabilitation intervention is designed to be a comprehensive package of care consisting of exercise training and self–management education, delivered by a multidisciplinary team. Patients will attend the rehabilitation classes within 10 days of hospital discharge. Rehabilitation involves two supervised classes per week for eight weeks, a Home Exercise Programme and education sessions.

Aims:

• To determine the effectiveness of an early rehabilitation intervention in improving exercise capacity and health status compared with usual standard care
• To determine the feasibility and safety of delivering this intervention
• To explore whether early rehabilitation can reduce health care usage compared to usual standard care
• To observe muscle strength and physical activity during an exacerbation and during the recovery process

Further information: Patients have been involved in the design of this study from its infancy. Five current CHF rehabilitation patients, who have all been hospitalised with their condition, reviewed all patient documentation and made comments. We are currently seeking one of our previous patient responders to stay connected with the project in future, by attending our CLAHRC steering group meetings, for example. If you would like to be involved in this study, or for more information, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Start date: 08/11/2010                                                                                                                    Expected end date: 28/02/2013

Study outcomes:

• The primary outcome measure is the change in Incremental Shuttle Walking Test distance at three months
• Other outcome measures include; demographic data, primary diagnosis, exercise performance, health status and symptoms, psychological status, muscle strength, physical activity and health care utilisation

If this trial proves the concept that early rehabilitation can improve symptoms and health status, then we would seek to design a larger trial to detect reduced healthcare utilisation. Should this intervention be shown to reduce healthcare use and be cost-effective, we would look to disseminate findings to clinicians and commissioners, to influence a change of practice that is supported by evidence.