Mortality rates post Heart Failure exercise rehabilitation program Stephen Woodruffe, AEP - Ipswich Heart Failure Service

“How long before I am going to die?” NHS, 2013

NHS, 2013

“Less than 50% of patients survive 5 years after diagnosis” The 1 year, 3 year, 5 year, and 10 year survival rates in the entire CHF group were 78.5%, 59.8%, 50.4% and 14.7%, respectively …about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year At 5 years, survival was 45%. Is this still the case???

Aim To review the death rates of patients who attended the Ipswich Heart Failure Service (IHFS) exercise rehabilitation program, from its inception in 2010. To assess number of patients deceased, time from last attendance at program to death, number of sessions attended before death To ascertain whether there is a correlation between increased exercise attendance and greater survival benefits

The IHFS AEP Service Model Referral received from HFS nurse or external HFS The IHFS AEP Service Model Initial EP Assessment Gym/Home/Phone/Telehealth MDT Input HF Exercise Rehab Program Continue Independently Other eg Community based exercise groups/gyms Telephone/Telehealth Based follow-up Home visits

The HF exercise rehabilitation program 10-12 week program Up to two supervised gym sessions per week Individualised exercise prescription Home exercise program strongly encouraged Cardiovascular training, strength, balance, core stability and stretching Progression to maintenance program

Our rehabilitation gym Our rehtion gym Our rehabilitation gym

Method Program attendance data was retrospectively reviewed for the period February 2010 to May 2017  Key measures Number of sessions attended Last date of attendance A follow-on review of patient death data was carried out, specifically looking for evidence of patient’s deaths and dates of deaths

Results – the raw numbers 210 patients attended at least 1 exercise session 60 female (28.6%), 150 male (71.4%) 40 patients deceased at the time of review (19%) – 11 female A number of patients had attended the program two or three separate times

Results – Sessions attended Patients found to be deceased had attended an average of 18 sessions (range 1-62) All other patients had attended an average of 14 sessions (range 1-71) Average: 18 sessions Average: 14 sessions

Results – “Time to death” Average “time to death” was 26 months post last exercise session Six (6) patients died while enrolled in program Four (4) patients [10%] survived >60 months (5 years) post exercise program, before death Thirteen (13) patients (33%) survived >36 months (3 years) Nineteen (19) patients (48%) survived >24 months (2 years) Average “time to death” was 26 months post last exercise session attendance However the distribution ranged from 0 months to almost 6 years post last exercise session Six (6) patients died while enrolled in program or within one month of last exercise session 26 patients (65%) survived at least a year

Discussion – points of interest Three (3) original patients of the first exercise program in 2010 remained alive >7 years post program Snapshot of patients (n=23) who attended the service > 5 years prior to review showed 15 patients (65%) remained alive compared to eight deceased There seems to be no correlation between greater attendance in the exercise program improving survival outcomes Deceased patients attended an average of 18 sessions compared to Alive patients attending an average of 14 sessions

References End of life care in heart failure - A framework for implementation, NHS, 2013 Long-term prognosis of patients with congestive heart failure. Matoba et al., 1990 Heart Failure patients too optimistic - study shows patients overestimate their life expectancy, WebMD, 2008 Death in Heart Failure - a community perspective, Henkel et al., 2008.

Thanks steve.woodruffe@health.qld.gov.au