Heart Failure Exercise programme

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Heart Failure Exercise programme

• A programme solely for people with Heart Failure
• Project is based on good practice in heart
  failure management from the National Institute
  Clinical Excellence (NICE) (2010) Management of
  Chronic Heart Failure in adults in primary and
  secondary care.
• The study is led by Chelsea and Westminster
  HospitalPam Copeland Project Lead Heart
  Failure CNSFiona Milligan Project Lead for
  Exercise Pathway Cardiac Rehabilitation
  CNS/Clinical Lead Non Medical Prescribing
• In association with West Middlesex University
  Hospital

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Why are we doing this?

• Heart Failure affects about 900,000 people in UK
  (NICE 2010)
• There is evidence of efficacy and safety of
  exercise
• Associated with a reduction in all cause and
  cardiovascular morbidity
• Prevalence expected to rise by 20 largely due to
  ageing population
• Average age Heart Failure patient 74 years
• Cardiomyopathies often younger population
• Traditional Cardiac rehabilitation not suited to
  Heart Failure
• Functional capacity
• Cardiac rehabilitation not resourced or funded
  for potential increased numbers
• Excluded from joining a gym
• High risk

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It all began with a cup of coffee!

• When the Cardiac Rehabilitation and Heart Failure
  Nurse Specialists had an idea!
• RD Poster presentation Chelsea and Westminster
  Hospital 2009
• Registration of Interest to the full application
  and subsequent approval Jan 2010

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Example of Methodologies PDSA for the Exercise
programme
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Outpatient Exercise programme

• The study focuses on
• Improving functional capacity and quality of life
  
• Reduction in hospital admissions
• Reduction in BNP levels measured pre and post
  programme
• Process
• Chelsea Westminster Hospital
• 48 participants recruited meeting the inclusion
  criteria (10 people per 8 week programme)
• Invited to an hour exercise session at hospital
  gym for 8 weeks and progress to community group
• Screening before exercise
• West Middlesex University Hospital
• Matched case control study n48
• Exclusion criteria
• New York Heart Association Classification (NYHA)
  Class IV (unstable heart failure)
• Hypotension with systolic blood pressure of lt80
  mmHg.
• Resting heart rate gt100
• Uncontrolled angina

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Programme structure
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Contemporary exercise

• Warm up
• 6-10 stations 2-4 minutes including active
  recovery
• Tailored to the individual
• Treadmill
• Bikes- Recumbent/ upright portable
• Rower
• Weights/ Velabands/ Ball/ Steps walk
• Cool down
• Factors affecting attendance
• working/ main carer/ time of day
• Ways we are overcoming this
• Individual programme catered for the individual
• Fast track to appropriate community arm of the
  project

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Outpatient Exercise programme

• Outcome measures
• Number of participants consented for the exercise
  cohort and matched control group
• Analysis of exercise Borg score following each
  exercise session
• Comparison of pre and post programme (at 16
  weeks) and at 1 year in both cohorts
• BNP will be measured
• Functional capacity assessment using the 6 minute
  walk test
• Quality of life using EQ5D questionnaire
• Comparison of readmission rates between exercise
  and matched case control group
• How is our study different
• Not restricted by post code
• Not restricted to Left Ventricular Systolic
  Dysfunction
• No age limitations.
• NYHA Class I to III
• Matched case control study to examine variables
• All participants will be given a functional
  capacity report

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Sustainability when CLAHRC funding ends

• Discussed from the beginning of the project
• Talked about our project to everyone
• Started to embed the project into daily working
• Engaged Senior managers and provided regular
  feedback of progress
• Engaged allied health professionals
• Training sessions and workshops for BACR/
  Physiotherapists Exercise instructors Community
  Volunteer groups
• Engaged other venues for Exercise
• Funded Exercise Instructor for BACR training
• Kensington Chelsea Leisure Services
• Engaged Commissioners PCTs
• GP newsletter
• Need to engage GP consortias
• Meetings

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Is the hard work worth it?Patient feedback

• This is great. Its like a mini David Lloyd!
• 67 yrs, NYHA II, ICD for VF arrest.
• Previously excluded from a gym
• Beaming smile walked 60 metres
• 73 yrs, NYHA III, obese, multiple co-morbidities
• Never exercised before
• Participants encouraging others
• 50 yrs, NYHA III, obese, multiple co-morbidities
• Never wanted to exercise before
• Improving body image confidence
• 49 yrs, NYHA II, multiple co-morbidities
• Depression
• So pleased to be part of something like a normal
  person
• 64 yrs, NYHA II, prophylactic ICD
• Previously fairly isolated at home now working

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Oh yes, indeed it is! After only 3 weeks of
exerciseWatching people previously excluded
from exercise having a great time! Seeing
participants' bond as a group and support each
otherHearing laughter and jokes as they
exerciseSeeing an improvement in confidence and
general well-being

• Thank you