Impact of home-based cardiac rehabilitation in people with heart failure with elevated depressive and anxiety symptoms: a secondary analysis of the REACH-HF randomized trials
Clinical Snapshot
PICO Framework
| P — Population | 263 patients with heart failure (HFrEF and HFpEF) with elevated depression (24%) or anxiety (33%) symptoms measured by HADS |
| I — Intervention | REACH-HF home-based cardiac rehabilitation programme plus usual care |
| C — Comparator | Usual care alone |
| O — Outcomes | Depression and anxiety scores (HADS), health-related quality of life (MLHFQ, HeartQoL), and accelerometer-measured physical activity at 6-12 months |
Bottom Line
This secondary analysis of the REACH-HF trials demonstrates that heart failure patients with elevated depression or anxiety symptoms derive greater mental health and quality of life benefits from home-based cardiac rehabilitation compared to those without elevated symptoms. The study found significant improvements in depressive symptoms and quality of life measures among participants with baseline depression, while those with anxiety showed improvements in some quality of life domains and physical activity measures. However, the analysis is limited by its secondary nature, small subgroup sizes, and use of screening rather than diagnostic tools. While promising, these findings require confirmation through adequately powered primary studies using clinical diagnostic interviews. For Australian clinicians, this suggests that home-based cardiac rehabilitation may be particularly beneficial for heart failure patients presenting with concurrent mental health symptoms, supporting a more personalised approach to rehabilitation referrals.
Key Findings
P Value: Significant interactions: HADS-D p=0.004, MLHFQ p=0.007, HeartQoL p=0.001 for depression group
Effect Size: Greater improvements in participants with elevated baseline symptoms
Primary Outcome: Depression and anxiety symptoms, health-related quality of life, and physical activity
Nnt Or Sensitivity: Not calculable from available data
Confidence Interval: Not reported in abstract
Clinical Application
Home-based cardiac rehabilitation is feasible and increasingly available in Australian healthcare settings Relevant to Australian practice where cardiac rehabilitation is supported through Medicare and aligns with CSANZ guidelines for heart failure management. Could inform PBS considerations for home-based programmes Heart failure patients with elevated depression or anxiety symptoms suitable for home-based rehabilitation
Abstract
AIMS: This study examined whether elevated baseline depression and anxiety moderated the effects of the REACH-HF home-based cardiac rehabilitation (CR) programme on patient outcomes in individuals with heart failure. METHODS AND RESULTS: Individual patient data from 263 patients with HF from the REACH-HF HFrEF and HFpEF trials were analysed. At baseline, 62 (24%) had elevated depression [Hospital Anxiety and Depression Scale (HADS) D > 7], and 86 (33%) had elevated anxiety (HADS-A > 7). Patients were randomized to home-based CR plus usual care or usual care alone. Outcomes at 6-12 months included depression and anxiety (HADS), health-related quality of life (HRQoL) [Minnesota Living with Heart Failure Questionnaire (MLHFQ), HeartQoL], and accelerometer-measured physical activity (PA). Linear regression models, adjusting for baseline values, stratification variables, and confounders, included interaction terms (baseline depression/anxiety ×intervention group) to assess moderation effects. Those with elevated depression showed greater benefits from CR effects in depressive symptoms and HRQoL, with significant interactions for HADS-D (P = 0.004), MLHFQ (P = 0.007), HeartQoL (P = 0.001). No effects were found for PA. In participants with elevated anxiety, significant interactions were observed for HADS-D (P = 0.024), HeartQoL physical (P = 0.04), inactivity (P = 0.02), and light PA (P = 0.04). No effects were found for anxiety symptoms or HRQoL measures. CONCLUSION: People with HF participating in REACH-HF with elevated depression and anxiety experienced greater improvements in their mental health and HRQoL than individuals without elevated symptoms. Diagnostic clinical interviews in future studies would allow for stronger conclusions regarding the impact of home-based CR on patients with confirmed depression or anxiety.
References
- 1.Lambert, J., Dibben, G., van Beurden, S. B., Bollen, J., Dalal, H., Blakemore, A., & Taylor, R. S. (2026). Impact of home-based cardiac rehabilitation in people with heart failure with elevated depressive and anxiety symptoms: a secondary analysis of the REACH-HF randomized trials. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvaf196
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