[2018] 6.3.2.3 Cardiac transplantation 65.Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock [2003] Chronic Heart Failure Rehabilitation in chronic heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 7 Rehabilitation in chronic heart failure The update to the heart failure guideline includes topics where new evidence has emerged since the publication in 2010. A review of new evidence published after 2010 was carried out in order to determine whether any changes to current recommendations where likely to be required. The decision on which topics to include in the update of the guideline was made following consultation of the scope. In this section new evidence on home versus centre based cardiac rehabilitation was reviewed. 7.1 Home-based versus centre-based rehabilitation The importance of rehabilitation therapy has been recognised for many years in the management of patients post-myocardial infarction. Many patients with heart failure, especially those with heart failure with reduced ejection fraction (HFREF) have an underlying basis in myocardial iscahemia and previous myocardial events. A number of studies have investigated whether rehabilitation techniques deliver similar benefits in patients with heart failure to those achieved in patients after a myoacrdila infarct. The organisation of heart failure services is evolving to favour home and community-based interventions as opposed to hospital-based provision. There are known inequalities in access to hospital-based rehabilitation services across the UK. This question investigated whether home-based rehabilitation services could deliver similar outcomes to hospital- based rehabilitation services. 7.1.2 Review question: What is the clinical and cost effectiveness of home-based versus centre- based rehabilitation (that includes an exercise element) for people with heart failure (HF)? For full details see review protocol in appendix A. 