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

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

3. NHS, 2013

4. “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???

5. 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

6. 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

7. 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

8. Our rehabilitation gym
Our rehtion gym
Our rehabilitation gym

9. 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

10. 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

11. 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

12. 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

13. Discussion – points of interest
Three (3) original patients of the first exercise program in 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

14. 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.

15. Thanks