Caregiver outcomes of the REACH-HF multicentre randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction.

The study was powered for patient outcomes, not caregiver outcomes, so real caregiver effects could be missed. Caregivers were allocated with their patients and were not randomised separately, so differences between caregiver groups could reflect selection or baseline imbalance. Control caregivers were older and had higher depression and anxiety scores and lower generic health-related quality of life at baseline. Many caregivers already had good functioning at baseline, leaving little room for measured improvement. No imputation was done for missing data, and 12-month outcome data were available for 45 of 53 REACH-HF caregivers and 37 of 44 control caregivers. The qualitative interviews were done only with REACH-HF caregivers, so they cannot compare views with control caregivers. The trial process evaluation found facilitators were less effective involving caregivers than patients, so the caregiver component may have been delivered unevenly. REACH-HF was a multi-component home programme, so the study cannot separate the effects of patient education, caregiver support, goal setting, the family resource and the walking element.

Funding came from the National Institute for Health Research. The supplied text does not state any author conflicts of interest.

Do not conclude that REACH-HF improved caregiver wellbeing broadly. Only confidence in supporting self-care differed from control; anxiety, depression, burden and quality-of-life differences were not significant, and the study was powered for patient outcomes rather than caregivers.