ESC Congress 2026 Abstract · Oct 26, 2026
Baseline characteristics of a contemporary trial of home-based cardiac rehabilitation in patients with heart failure and preserved ejection fraction – the REACH-HFpEF trial
By Lang C, Mordi IR, Taylor RS
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