Morbidity and mortality following heart failure rehabilitation: The effect of programme completion and 6-min walk test distance

Abstract

Objective To compare real-world data from a single centre heart failure rehabilitation programme, evaluating the effect of programme completion and improved functional capacity on morbidity and mortality in patients with heart failure. Design A retrospective longitudinal analysis of service outcomes. Setting A single-centre London based NHS trust. Participants Patients attending heart failure rehabilitation between 2016 and 2020. Intervention Patients participated in a 12-week heart failure rehabilitation programme with those completing ≥6 rehabilitation sessions classified as ‘completers’. Main Measures Pre and post 6-min walk tests measured improvement in physical ability, depicted by a meaningful increase in distance (≥30 m). Kaplan–Meier survival analysis was used to predict risk of event (myocardial infarction, cerebrovascular accident, heart failure readmission and death) between ‘completers’ and ‘non-completers’. Kaplan–Meier Log rank was employed for ‘completers’, examining time to event between ‘improvers’ (6-min walk test ≥30 m) and ‘non-improvers’ (6-min walk test <30 m). Results 137 patients (male 61%) attended heart failure rehabilitation over the 4-year period. 86% (n = 117) of patients completed the programme. During the follow-up period, there were 25 events, including three deaths. There was no statistically significant difference in time to event between completers and non-completers, (P = 0.563). Improvement in 6-min walk test results demonstrate some short-term benefit, however no long-term benefits in morbidity and mortality were seen (P = 0.888). Conclusions Completion of heart failure rehabilitation is not associated with a lower risk of combined event in this study. Improved 6-min walk test appears to be associated with short-term advantage in event-free survival time.