Cardiac rehabilitation for patients with heart failure - KiActiv

The challenge

Cardiac rehabilitation (CR), delivered traditionally as face-to-face exercise classes, offers significant benefits for patients with heart failure (HF). However, its uptake and adherence is generally low due to barriers such as; lack of knowledge about its benefits, depression, anxiety and/or low motivation, fear of inadvertently worsening symptoms, comorbidities that limit physical activity, and socioeconomic factors such as low income and lack of transportation.

According to the 2024 National Audit of Cardiac Rehabilitation (NACR), only 13% of eligible patients with heart failure in England actually start cardiac rehabilitation.

The desired outcomes of this pilot are to increase the percentage of heart failure patients completing some form of cardiac rehabilitation, reduce the amount of emergency re-admissions, and shorten waiting times for access to cardiac rehabilitation.

Population

Adults diagnosed with heart failure and who are eligible for cardiac rehabilitation and are from the appropriate catchment area to be referred to the Hampshire and Isle of Wight Healthcare team (the purchase of the 100 additional licences will enable KiActiv to be offered to all of these patients until March 2026 and potentially beyond).

What we did

KiActiv is one of the short-listed innovations on the national heart failure programme and Health Innovation Wessex facilitated a pilot of the technology at Hampshire and Isle of Wight Healthcare NHS Foundation Trust who are commissioned to provide the cardiac rehabilitation services for University Hospital Southampton (UHS). The team had previously piloted a digital intervention providing patients with videos and information to exercise at home, but with limited uptake and success.

Health Innovation Wessex facilitated a meeting between KiActiv CEO Tommy Parker and key stakeholders from the relevant organisations, ascertained the appetite to run a pilot, assessed existing pathways and how the technology could be incorporated and funded the purchase of an initial trial of 20 licences.

Part of this process involved the establishment of a working group to meet on a regular basis dependent on the stage/needs of the project. This ensured that stakeholders from each of the relevant organisations were involved from the outset, that all angles were covered including governance and that the project had the greatest chance of being successful. With this group in place proposed changes during the delivery phase could be discussed and agreed quickly, such as the decision to offer all heart failure patients KiActiv prior to face-to-face rehabilitation, which was implemented part way through the initial pilot.

"Health Innovation Wessex have been invaluable in supporting the adoption of KiActiv® in their region and beyond. The efforts of Rob, Jo, Nina and the team have facilitated introductions to local clinical teams with aligned needs, and their assistance in managing the initial pilot implementation has been critical. They've also given us the platform to demonstrate the value of our solution with other regions through the Heart Failure Community of Practice, and we look forward to collaborating on future projects."

Tommy Parker, Chief Executive Officer, KiActiv

To date, all the initial 20 licences have been allocated, two patients have completed the 12-week programme and Hampshire and Isle of Wight Healthcare are in the process of purchasing an additional 100 licences to extend the pilot using service development funding (SDF).

As well as funding the initial pilot and offering project management support, Health Innovation Wessex has provided Tommy (KiActiv) with the opportunity to present to health innovation networks from across the country via our monthly Heart Failure Community of Practice meetings and at large external healthcare innovation events. Health Innovation Wessex have also introduced the innovator to key stakeholders from the Dorset health and care system, where we are currently scoping the possibility of running a similar pilot.

Impact

The objective was to implement and deliver a pilot of KiActiv as an alternative and/or precursor to traditional cardiac rehabilitation, provide evidence of the outcomes and dependent on the success of the project, support a case for ongoing funding/commissioning.

At the time of writing, the pilot is currently being delivered, with all 20 licences allocated and two patients having reached the end of their 12-week course. Initial results are good with a considerable increase in daily activity. Positive feedback from staff and patients regarding ease of use and simple onboarding process has prompted Hampshire and Isle of Wight Healthcare to extend the pilot. They are currently in the process of purchasing additional licences with service development funding (SDF). It is hoped that all patients using KiActiv will engage with the programme, regularly check their data, increase their day-to-day physical activity, and avoid any unplanned hospital admissions via A&E.

The final patients from the initial cohort of twenty will have completed their 12 week course by December 2025 and a report is planned for publication in February 2026. In addition to this, patients are already being onboarded using the extra licences purchased with SDF funding and new data will be added incrementally.

As patients keep the wearable and access to their dashboard data beyond the duration of the 12-week programme it is also hoped they will continue to track their activity, build on the improvements made and stay healthier for longer through self-management of their condition.

KiActiv is an end-to-end service, meaning there is no added burden to the cardiac rehab staff from Hampshire Isle of Wight Healthcare beyond initially referring patients to the programme and reading the regular progress updates that KiActiv provides. This frees up capacity to see other patients and has the potential to reduce the waiting list for face-to-face cardiac rehabilitation.

A trial of KiActiv in Liverpool for patients being discharged from a heart failure virtual ward shows that the programme has helped to reduce hospital readmissions, improve the uptake of rehabilitation, save costs, and enhance recovery.

Economic success

Data collected from the KiActiv project in Liverpool demonstrates the potential for significant cost savings based on increasing patient uptake and reducing the number of hospital readmissions. Based on a model cohort of 20,000 the net cost savings of using KiActiv are projected to be over £8.8 million. Although a slightly different delivery model to the project in Southampton, both are specifically for patients with heart failure, and the same rationale would be applicable.

Patient contribution

Patients have contributed meaningfully to the design and evolution of KiActiv, primarily through real world feedback, personalised use cases, and collaborative development with NHS services.

The innovation has patient centred design principles built around the idea that everyday movement matters, especially for those who find traditional exercise inaccessible. This reflects feedback from patients with chronic conditions who need a more flexible, inclusive approach.

The one-to-one mentoring provides empathy, guidance, and reassurance for patients with complex health conditions such heart failure.

Spread and adoption

The Health Innovation Wessex (HIW) Innovation Adoption Model provides an evidence informed approach to guide the adoption of innovation. Application of this model involved work to understand both the innovation and the adopter by exploring the adopter’s readiness for adoption and the context in which the innovation was being implemented. We established a working group with key stakeholders, developed an understanding of the mechanisms to support delivery of the project and worked in an agile way to adapt the implementation plan when needed.

Future plans

Hampshire Isle of Wight Healthcare is also in the process of purchasing an additional 100 licenses using service development funding (SDF). Dependent on the timeframe this should enable continuous access to KiActiv until the end of the financial year (2025-26) and potentially beyond.

Health Innovation Wessex and KiActiv are currently exploring the potential for adoption in the other geographical regions (places) that are served by the Hampshire and Isle of Wight Integrated Care Board (Portsmouth, Isle of Wight, Mid/North Hampshire) and Dorset. As chair of the Health Innovation Network’s Heart Failure Community of Practice, Health Innovation Wessex has also given KiActiv the opportunity to present to the other HINs involved in the national heart failure programme.

Supporting government priorities

This work meets all five government priorities as it is digital, it can help prevent cardiovascular events, treats people at home and by building on their day to day activity, tackles health inequalities (patients don’t have to impact their work by travelling to and attending physical classes) and the lack of travel supports net zero.

Network support

KiActiv is supported by the Health Innovation Network’s national heart failure programme and is on a shortlist of innovations relating to heart failure, recommended for adoption and spread and was on the NHS Innovation Accelerator (NIA) in 2021 (supported by the regional health innovation networks). This has provided the innovator with proactive support to access the NHS market and enabled the company to benefit from the Network’s accelerated product development programmes, implementation support and evaluation expertise.