Similarly, a patient representative expressed his view that the main concern of many younger patients with heart failure is to learn and understand their limits with professional supervision, to enable them to then exercise safely and comfortably alone. The committee expressed its concern about the continuing low uptake of rehabilitation since the previous guideline52 and agreed that there may be inequalities in the ability to access rehabilitation, especially for older, frailer patients with heart failure. The committee agreed that the delivery of home-based rehabilitation may increase access and uptake, which is a major priority in the management of heart failure. The committee considered that even a modest increase had the potential to result in a marked improvement in patient outcomes at the population level. The committee also discussed the potential downsides of a home-based programme, including: the loss of face-to-face support and encouragement from health professionals and peers, especially compared with a group programme; increased feeling of isolation for some patients; the potential for reduced adherence among some patients, and for patients to experience technological and comprehension barriers to full participation, which may not be picked up in patient self-reports. On balance, the committee agreed that choice of participating in a more traditional and supervised centre-based programme or a home-based programme should ideally reflect the preference of the individual patient. The committee therefore decided to maintain the current recommendation to offer cardiac rehabilitation to heart failure patients, but removed the limitations on the mode of delivery. The committee agreed that the setting and format of the programme should facilitate the person s ability to access the programme. The committee noted that several comprehensive, evidence-based, home-delivered cardiac rehabilitation programmes are currently available. 