Impact of home-based cardiac rehabilitation in people with heart failure with elevated depressive and anxiety symptoms: a secondary analysis of the REACH-HF randomised trials

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 randomised 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 (Minnesota Living with Heart Failure Questionnaire [MLHFQ], HeartQoL), and accelerometer-measured physical activity. 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 health-related quality of life, with significant interactions for HADS-D (p = 0.004), MLHFQ (p = 0.007), HeartQoL (p = 0.001). No effects were found for physical activity. 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 physical activity (p = 0.04). No effects were found for anxiety symptoms or health-related quality of life measures. Conclusion People with HF participating in REACH-HF with elevated depression and anxiety experienced greater improvements in their mental health and health-related quality of life than individuals without elevated symptoms. Diagnostic clinical interviews in future studies would allow for stronger conclusions about the impact of home-based CR on patients with confirmed depression or anxiety.