Setting: 15 sites across England, Scotland, and Wales.

Intervention: REACH-HF is a comprehensive home-based cardiac rehabilitation (CR) and self-management programme informed by evidence, theory and service user perspective. It comprises the ‘Heart Failure Manual’, a Relaxation CD, a choice of exercise (walking programme or a chair-based exercise DVD), a ‘Progress Tracker’ tool for patients, and a ‘Family and Friends Resource’ for caregivers. Participating patients and caregivers work through the manual over a 12-week period with facilitation by a trained healthcare professional (e.g. heart failure-specialist nurse or rehabilitation physiotherapist) using both face-to-face support and telephone support.

Control: both intervention and control patients will receive usual medical care.

Primary outcome: Minnesota Living with Heart Failure Questionnaire score at 12-months.Secondary outcomes: deaths and hospital admissions; blood-borne biomarker; exercise capacity; physical activity levels; psychological well-being; generic quality of life; frailty; selfcare; self-efficacy. Caregivers: burden, generic quality of life, psychological well-being; Collected at baseline (pre-randomisation), and 4 and 12-month post-randomisation.

Data analysis
Statistics: Main analysis will take an intention-to-treat approach (based on complete data at 6-months). For continuous outcome measures, we will use mixed-effects regression with a random effect of recruiting site and adjusting for baseline outcome score and minimisation variables.

Economic evaluation: With-in trial cost-utility analysis over the 12-months.

Process evaluation: Case-based mixed methods analysis.

Timetable
Months 1-6: Setup (approvals, site selection/recruitment, CRF/database development, patient identification); Months 7-36: Recruitment for 18-months (months 7-15: 9-month internal pilot and months 16-24: remaining recruitment completion) and follow-up for 12-months (month 36: end of 12-month follow-up); months 37-42: Analysis, reporting, and dissemination.

Expertise
Multidisciplinary research team: established track record in the successful delivery of complex intervention pragmatic trials with expertise in cardiology, rehabilitation, clinical trial design, behaviour change, biostatistics, health economics, process evaluation, and patient and public involvement.

Impact
Given their high unmet need for effective and cost-effective therapies, if positive, the findings
of this trial will fundamentally impact the outcomes research of HFpEF patients and their care givers. Results will inform future national and international guideline and provide guidance to health professionals and healthcare commissioners on the need for rehabilitation and how to deliver it efficiently and effectively.