Overall, the committee did not consider that home-based rehabilitation would be more costly than hospital/community rehabilitation as health professionals are not required to visit patients in their homes, and in some instances could be less costly. The lack of uptake of rehabilitation since the previous guideline has meant that the cost savings previously predicted due to reductions in hospitalisations have not come to fruition. Although there is no clinical evidence for hospitalisations the committee considered that home-based rehabilitation would have the same effect in reducing hospitalisations as hospital or centre based rehabilitation. Therefore the cost savings of rehabilitation are more likely to be met if home based rehabilitation is made available to aid in increasing the uptake of rehabilitation. The committee mentioned that in some areas hospital/centre-based rehabilitation is not available due to the significant up-front cost required to initiate the service. The committee agreed that initiating home-based rehabilitation programmes is unlikely to incur as high a cost, particularly if existing cardiac rehabilitation programmes are already in place, and considered that this recommendation would aid in reducing barriers to access. Due to the considerations above, the committee decided that home-based rehabilitation should be available for heart failure patients to increase uptake of rehabilitation and facilitate the previously predicted cost-savings. Other considerations The committee noted that access to cardiac rehabilitation for heart failure patients is currently highly variable and uptake nationally remains low. The committee s recommendation should address some of the underlying issues by improving access, equity, participation and adherence. The CHF Quality standard (QS9 2016, statement number 7) identified the need for choice of venues and measures such as providing transport when offering rehabilitation programmes to ensure equality of access for all the heart failure population. 