Baseline characteristics of a contemporary trial of home-based cardiac rehabilitation in patients with heart failure and preserved ejection fraction – the REACH-HFpEF trial

Aim

Reduced exercise capacity and poor health-related quality of life (HRQoL) are hallmarks of heart failure with preserved ejection fraction (HFpEF), which exercise-based cardiac rehabilitation (ExCR) may improve. However, prior randomised trials of ExCR in HFpEF have been small and possibly unrepresentative of contemporary patients. REACH-HFpEF is a large pragmatic United Kingdom (UK) randomised controlled trial of ExCR in HFpEF.

Purpose

This study describes participants’ baseline characteristics and compares them with recent HFpEF trials and registry datasets.

Methods

REACH-HFpEF is a randomised trial with 1:1 patient level allocation to home-based REACH-HF ExCR programme plus usual care or usual care alone across 20 UK National Health Service centres. The primary outcome is disease-specific HRQoL at 12 months, measured using the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Secondary outcomes include exercise capacity, psychological well-being, physical activity, generic HRQoL (EQ5D mapped to UK value set), frailty, blood biomarkers, mortality, hospitalisations, and serious adverse events. Baseline characteristics are summarised and compared with study-level data from recent HFpEF exercise and pharmacological trials and HFpEF registry cohorts.

Results

The REACH-HFpEF trial completed enrolment of 392 patients in May 2025, exceeding the target sample size of 372. Median age was 79.2 years (min: 46.3; max: 93.2), 53% were women, and median body mass index (BMI) was 29.7 kg/m2. Median left ventricular ejection fraction was 55.0% and the median N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 1738 ng/L. Overall, 65% of participants were classified as New York Heart Association class II and 35% class III. Median MLWHF total score was 40.0, and median EQ5D utility score was 0.653.

Comorbidity prevalence was similar across studies. However, compared with recent ExCR and pharmacological HFpEF trials , REACH-HFpEF participants were older, had higher NT-proBNP levels, worse self-reported HRQoL (Figure) and lower baseline exercise capacity. Use of renin-angiotensin system inhibitors and beta-blockers was similar across all studies, however in REACH-HFpEF, a higher proportion of patients were treated with sodium-glucose cotransporter 2 inhibitors (46%) and loop diuretics (97%) compared with prior HFpEF ExCR trials.

Conclusion

REACH-HFpEF is the largest global trial of ExCR in HFpEF to date and has enrolled a heterogenous population that reflects “real-world” clinical practice. Participants were older and had higher plasma NT-proBNP, greater symptom burden, and poorer HRQoL than those in many previous ExCR trials. Background medical therapy was typical for contemporary HFpEF populations, enabling a robust assessment of the benefits of ExCR in this population and enhancing the generalisability and applicability of our trial findings.NTproBNP/KCCQ: REACH-HFpEF