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.
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.
| Original language | English |
|---|---|
| Article number | zvaf196 |
| Journal | European Journal of Cardiovascular Nursing |
| Early online date | 15 Oct 2025 |
| DOIs | |
| Publication status | Published - 15 Oct 2025 |
Bibliographical note
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.Data Availability Statement
The data underlying this article will be shared on reasonable request to the corresponding author.Funding
Data sourced from REACH-HF trial funded by UK National Institute Health Research (NIHR) grant number RP-PG-1210-12004. The views expressed in this publication are those of the authors and not necessarily of the NIHR or UK's Department of Health and Social Care.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
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