Effects of Baduanjin exercise on quality-of-life and exercise capacity in patients with heart failure: A systematic review and meta-analysis.

PURPOSE: Exercise training is an efficient non-pharmacological intervention for patients with heart failure (HF). This study aimed to objectively evaluate the effects of Baduanjin exercise on the quality of life (QOL) and exercise capacity in patients with HF. METHODS: PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data were searched from the date of their inception until 30 September 2022. All randomised controlled trials (RCTs) evaluating the effects of Baduanjin exercise on QOL and exercise capacity in patients with HF were selected. The primary outcomes were QOL, assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and exercise capacity, evaluated using the 6-min walking test (6-MWT). A meta-analysis was performed by comparing the MLHFQ domain scores. Review Manager 5.3 and Stata 14.0, were used for the data analysis. RESULTS: Baduanjin exercise showed a favourable improvement of the overall QOL (mean difference = -8.25; 95% confidence interval: -13.62 to -2.89; P = 0.003) and exercise capacity (mean difference = 118.49; 95% confidence interval: 52.57 to 184.41; P = 0.0004). Meta-analyses of the MLHFQ domain score indicated that Baduanjin exercise significantly improved the patients' physical (mean difference = -2.83; 95% confidence interval: -3.76, -1.90; P < 0.00001), emotional (mean difference = -2.52; 95% confidence interval: -3.67 to -1.37; P < 0.0001), and general QOL (mean difference = -2.61; 95% confidence interval: -5.17 to -0.06; P = 0.05), based on the decrease in the MLHFQ domain score. Marked statistical heterogeneity (I2> 70%) was observed for all the QOL and exercise capacity outcomes. CONCLUSIONS: Baduanjin exercise is a safe, feasible, and acceptable intervention that can improve the QOL and exercise capacity in patients with HF. However, more RCTs with rigorous research designs are needed to assist in the rehabilitation of such patients.

The Need for Breathing Training Techniques: The Elephant in the Heart Failure Cardiac Rehabilitation Room: A Randomized Controlled Trial.

BACKGROUND: Although solid evidence has indicated that respiratory symptoms are common amongst patients with chronic heart failure (CHF), state-of-the-art cardiac rehabilitation (CR) programs do not typically include management strategies to address respiratory symptoms. This study investigated the effect of the addition of breathing exercises (BE) to the CR programs in CHF. METHODS: In a two parallel-arm randomized controlled study (RCT), 40 middle-aged patients with CHF and respiratory symptoms were recruited and randomized into two equal groups (n = 20); group (A): standard CR with BE and group (B): standard CR alone. Primary outcomes were respiratory parameters and secondary outcomes included cardiovascular and cardiopulmonary outcomes. All the participants attended a program of aerobic exercise (three sessions/week, 60-75% MHR, 45-55 min) for 12 weeks, plus educational, nutritional, and psychological counseling. Group (A) patients attended the same program together with BE using inspiratory muscle training (IMT) and breathing calisthenics (BC) (six sessions/week, 15-25 min) for the same duration. RESULTS: There was a significant improvement in the respiratory outcomes, and most of the cardiovascular and cardiopulmonary outcomes in both groups with a greater change percentage in group A (p < 0.05). CONCLUSIONS: These results indicate that the addition of BE to the CR programs in CHF is effective and is a "patient-centered" approach.

The effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure: an experimental study.

BACKGROUND: Heart failure is a common and chronic heart condition with high prevalence and mortality rates. This debilitating disease as an important predictor of health outcomes is directly related to patients' quality of life. Given that one of the main goals of heart failure treatment is to promote patients' quality of life and health status, conducting effective nursing interventions seems to be necessary in this regard. Therefore, the present study aimed to determine the effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure. METHODS: This is an experimental study in which a total of 80 patients with heart failure were recruited and randomly allocated to two groups of intervention and control (n = 40 in each group). The educational program was designed based on Pender's health promotion model and then provided for the patients in the intervention four subgroups (10 person in each group) during six sessions. Data were collected at three time-points of before, immediately after, and three months after the intervention using a demographic questionnaire, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Health-Promoting Lifestyle Profile II (HPLP-II). Data were then analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA) and p value less than 0.05 was taken as statistically significant. RESULTS: Based on the results of the present study, no statistically significant difference was shown in terms of demographic characteristics between the two groups. It was also indicated that there was a statistically significant difference in the mean scores of all dimensions of quality of life (except in the physical dimension) between the two groups so that the overall mean score of quality of life increased significantly in the intervention group after the intervention (p < .05). Moreover, there were significant increases in the mean scores of health-promoting behaviors (except in the domain of physical activity) in the intervention group compared to the control group (p < .05) after intervention. CONCLUSIONS: This study demonstrates a trend that Pender's health promotion model is effective in improving the quality of life of patients with heart failure except of the physical dimension, and strengthening their health-promoting behaviors in all dimensions except of the physical activity dimension.

A randomized controlled protocol on the effect of moxibustion on the cardiac function and quality of life in patients with chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is the final result of various cardiovascular diseases, with high morbidity and high mortality, which seriously threaten people's health and quality of life. It has become a public health problem in the world. There is currently no specific treatment. Moxibustion, as a complementary and replacement therapy, has advantages in the treatment of chronic heart failure, but it lacks standard clinical studies to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the effect of moxibustion on the heart function and quality of life of patients with CHF. METHODS: This is a prospective randomized controlled trial to study the effect of moxibustion on the heart function and quality of life of patients with CHF. This is approved by the clinical research ethics committee of our hospital. Patients were randomly divided into observation group (moxibustion combined with Western medicine treatment group) or control group (conventional Western medicine treatment group). There is a follow-up for 3 months after 6 weeks of treatment. Observation indicators include total effective rate of cardiac function improvement, Minnesota Living with Heart Failure Questionnaire , left ventricular ejection fraction , N-terminal pro-brain natriuretic peptide , 6-minute walk test , adverse reactions, etc. Data were analyzed using the statistical software package SPSS version 18.0 (Chicago, IL). DISCUSSION: This study will evaluate the clinical efficacy of moxibustion in the treatment of CHF. The results of this study will provide a reliable reference for the clinical choice of moxibustion as an adjuvant treatment for chronic heart failure. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/29XE7.

The Prevalence of Complementary and Integrative Health Approach Use and Quality of Life Among Patients With Heart Failure: A Cross-sectional, Descriptive, and Comparative Study.

This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL.

Efficacy and safety of Qishen granules for chronic heart failure: A protocol for systematic review and meta-analysis.

BACKGROUND: Qishen granules (QSG) is a famous traditional Chinese Medicine (TCM) formula used to treat chronic heart failure (CHF). The objective of this protocol is to clarify the efficacy and safety of QSG for treating CHF. METHODS: Six databases will be electronically searched up to November 1, 2020 for randomized controlled trials (RCTs) in English and Chinese languages. Two independent reviewers will complete tasks of literature retrieval and data extraction. After that, the Cochrane Collaboration risk of bias tool will be utilized to assess methodological quality. The primary outcomes are left ventricular ejection fraction, left ventricular fractional shortening, and N-terminal B-type natriuretic peptide. The secondary outcomes consist of composite cardiac events, adverse effects, and quality of life. Meta-analysis will be performed using the Revman version 5.3. RESULTS: This study will provide a high-quality synthesis of current evidence of QSG for CHF from primary and secondary outcomes. CONCLUSION: This study will provide evidence for the effectiveness and safety of QSG in the treatment of CHF. PROSPERO REGISTRATION NUMBER: CRD42020150442.

Living with advanced heart failure: A qualitative study.

INTRODUCTION: Information about how patients with advanced heart failure (HF) live and cope with their disease remains scarce. The objective of this study was to explore, from phenomenological and holistic perspectives, the experiences of patients suffering from advanced HF, attended at home in the primary care setting in 2018. MATERIALS AND METHODS: Qualitative study conducted in 4 primary healthcare centers in Barcelona (Spain). Twelve in-depth interviews were conducted in advanced HF patients, aged over 65 and visited regularly at home. We developed a purposeful sampling, accounting for variability in gender, age, and socioeconomic level. Leventhal's framework was used to analyze the interviews. RESULTS: Participants received insufficient and contradictory information about HF. They talked about their cognitive representation and claimed a better communication with healthcare professionals. Due to their advanced age, subjects considered their daily living limitations to be normal rather than as a consequence of HF. Gender differences in emotional representation were clearly observed. Women considered themselves the keystone of correct family "functioning" and thought that they were not useful if they could not correspond to gendered societal expectations. Cognitive coping strategies included specific diets, taking medication, and registering weight and blood pressure. Nevertheless, they perceived the locus of control as external and felt unable to manage HF progression. Their emotional coping strategies included some activities at home such as watching television and reading. Social support was perceived crucial to the whole process. CONCLUSIONS: Locus of control in advanced HF was perceived as external. Healthcare professionals should adapt emotional health interventions in patients with advanced HF based on a gender perspective. Social support was found to be crucial in facing the disease. Patients reported poor communication with healthcare professionals.

[Using lived experiences and theoretical insights to gain a better understanding of the adaptation difficulties encountered by elderly patients with chronic heart failure during the hospital-to-home transition]. / Mieux saisir les difficultés d'adaptation des personnes âgées insuffisantes cardiaques en transition de l'hôpital vers le domicile à partir des expériences vécues et d'un éclairage théorique.

Heart failure is one of the most common reasons for hospitalization in older people, and the hospital-to-home transition can be unsuccessful for these patients. Existing care programs focus primarily on the physiological aspects of the disease and are rarely based on theory. Using Roy's adaptation model (1), the aim of this study was to develop a thorough understanding of the adaptation difficulties and factors that influence how well elderly patients with chronic heart failure cope with the hospital-to-home transition, in order to develop a nursing interventions program. Based on the process proposed by Sidani and Braden (2011), this qualitative descriptive study adopted a deductive approach, with the use of intermediary theories and empirical data, as well as an inductive approach, where older people with chronic heart failure (n=7), caregivers (n=6), and healthcare professionals (n=14) participated in semi-structured individual interviews. The triangulation of data highlights the difficulties and factors influencing adaptation at the physical, psychological, and social levels. Gaining a better understanding of the experience of older people with heart failure when it comes to their transition from hospital to home, and doing so with a holistic vision, provides information for interventions that can contribute to better management of chronic disease and a better quality of life for these elderly patients.

Supportive Care Interventions to Promote Health-Related Quality of Life in Patients Living With Heart Failure: A Systematic Review and Meta-Analysis.

Supportive care (physical, psychosocial, and spiritual) may be beneficial as a coping resource in the care of patients with heart failure (HF). Nurses may provide individualised supportive care to offer positive emotional support, enhance the patients' knowledge of self-management, and meet the physical and psychosocial needs of patients with HF. The aim of this study was to examine the potential effectiveness of supportive care interventions in improving the health- related quality of life (HRQoL) of patients with HF. Related outcomes of depression and anxiety were also examined. A systematic search of PubMed, CINAHL, and the Cochrane Library was performed to locate randomised controlled trials (RCTs) that implemented any supportive care interventions in patients with HF published in the English language. Identified articles were further screened for additional studies. Ten (10) RCTs were selected for the meta-analysis. Effect sizes were estimated between the comparison groups over the overall follow-up period, and presented along with confidence intervals (CIs). Statistical heterogeneity for each comparison was estimated using Q (chi square test) and I2 statistics with 95% CIs. Statistical heterogeneity was observed in all study variables (i.e., HRQoL and dimensions). There was a positive, but not statistically significant, effect of social support on HRQoL (mean difference [MD], 5.31; 95% CI, -8.93 to 19.55 [p=0.46]). The results of the two dimensions suggested a positive and statistically significant effect of the supportive care interventions (physical: MD, 7.90; 95% CI, 11.31-4.50 [p=0.00]; emotional dimension: MD, 4.10; 95% CI, 6.14-2.06; [p=0.00]). The findings of the current study highlight the need to incorporate supportive care to meet the needs of patients with HF. Patients with HF have care needs that change continuously and rapidly, and there is a need of a continuous process in order to address the holistic needs of patients with HF at all times and not just in a cardiology department or an acute care setting. Patients with HF have multiple needs, which remain unmet. Supportive care is a holistic, ongoing approach that may be effective in identifying and meeting the care needs of patients with HF along with the patient. This review includes all interventions provided in individuals with HF, giving clinicians the opportunity to choose the most suitable ones in improving the clinical outcomes of their patients with HF.

Effect of a double nutritional intervention on the nutritional status, functional capacity, and quality of life of patients with chronic heart failure: 12-month results from a randomized clinical trial.

INTRODUCTION: Introduction: malnutrition is commonly associated with, and worsens the prognosis of heart failure. The management of chronic heart failure and its complications based only on the application of pharmacologic guidelines is incomplete. The benefits of interventions to improve nutritional status may be limited by the multifactorial nature of malnutrition. The objective of the present study was to determine whether nutritional advice and nutritional supplementation can improve the nutritional status of patients with chronic heart failure. Methods: we performed a randomized clinical trial on an intention-to-treat basis with blinded observers. We divided a sample of 76 patients into 2 groups: one that received structured advice combined with nutritional supplements for 12 weeks (test group), and one that received treatment as usual (control group). The outcome measure was nutritional status as evaluated using the Subjective Global Assessment and the Mini Nutritional Assessment tools. After 12 weeks of treatment the test group received a leaflet that served as a reminder. No further interventions were applied in either group. Patients were followed for 1 year. Results: at 3 months of follow-up nutritional status improved 4-fold in the test group, whereas no change was observed in the control group. At 9 months nutritional status in the intervention group had improved 2-fold with respect to the baseline visit, whereas no differences were recorded in the control group. Differences in mortality and length of stay at 1 year did not reach statistical significance.

INTRODUCCIÓN: Introducción: la desnutrición se asocia comúnmente con la insuficiencia cardíaca y empeora su pronóstico. El tratamiento de la insuficiencia cardíaca crónica basado exclusivamente en la aplicación de las guías clínicas farmacológicas resulta insuficiente. Los beneficios de las intervenciones para mejorar el estado nutricional pueden quedar enmascarados por el carácter multifactorial de la desnutrición. El objetivo del estudio fue determinar si el asesoramiento nutricional más suplementos nutricionales puede mejorar el estado nutricional de los pacientes con insuficiencia cardiaca. Método: ensayo clínico aleatorizado basado en la intención de tratar con evaluadores sometidos a enmascaramiento. Una muestra de 76 pacientes en 2 grupos: uno que recibió asesoramiento estructurado más suplementos nutricionales durante 12 semanas (grupo de intervención) y otro que siguió el tratamiento habitual (grupo de control). El parámetro del resultado fue el estado nutricional evaluado utilizando como herramientas la Valoración Global Subjetiva y el Mini Nutritional Assesment. Después de 12 semanas de tratamiento, el grupo de intervención recibió a modo de recuerdo un folleto informativo. No se aplicaron más intervenciones en ninguno de los grupos. Se siguió a los pacientes durante 1 año. Resultados: a los 3 meses de seguimiento, el estado nutricional mejoró cuatro veces en el grupo de intervención, mientras que no se observó ningún cambio en el grupo de control. A los 9 meses, el estado nutricional en el grupo de intervención había mejorado 2 veces con respecto a la visita inicial, mientras que no se registraron diferencias en el grupo de control. Las diferencias de mortalidad y estancia hospitalaria al cabo de 1 año no alcanzaron la significación estadística.

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management.

Objective Heart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. Methods Five general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. Results Barriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). Conclusions The HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic? Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add? This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners? The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure.

BACKGROUND: An estimated 6.5 million American adults live with heart failure (HF). Elevated anxiety symptoms may worsen HF symptoms and contribute to decreases in overall quality of life (QOL). Mindfulness has been associated with better psychological health with lower levels of anxiety symptoms. Mindfulness may be a modifiable target for reducing anxiety symptoms and increasing QOL in patients with HF. OBJECTIVE: The objective of this study is to examine the relationships among anxiety symptoms, dispositional mindfulness, and QOL in patients with symptomatic HF. METHODS: In this cross-sectional study, we conducted a secondary analysis of baseline data from 70 participants. We performed descriptive statistics, bivariate Pearson correlations, and multiple linear regression. RESULTS: The sample included 70 individuals with a mean age of 65 ± 10.5 years, 89% male, mean left ejection fraction of 45.7 ± 13.6, mean total QOL of 36.9 ± 21.7, mean total mindfulness of 82.2 ± 12.8, and mean anxiety of 4.8 ± 2.9. In multiple regression analyses, total mindfulness was significantly associated with lower anxiety (ß = -0.491, P < .01), greater observational mindfulness was significantly associated with lower anxiety (ß = -0.377, P < .01), and greater nonreactivity to inner experience was significantly associated with lower anxiety (ß = -0.320, P < .05). Lower anxiety was associated with greater total QOL (ß = 0.488, P < .01), greater physical QOL (ß = 0.381, P < .01), and greater emotional QOL (ß = 0.639, P < .01). CONCLUSIONS: Mindfulness may be a way of improving both anxiety symptoms and QOL in this population.

Relationship Between Praying and Self-Care in Elderly with Heart Failure: A Cross-Sectional Study in West of Iran.

Given the prevalence of Heart Failure (HF), the current study was conducted, aiming to determine the relationship between praying and self-care in the patients with HF in Iran in 2018. The type of the study is descriptive-analytical, which has been conducted in patient group of more than 65, suffering HF. The population of study has consisted of HF patients, referring to Shahid Mostafa Khomeini Hospital of Ilam province. Therefore, the patients, referring to this hospital for medical treatments, were included in this study. The study data were analyzed using software SPSS16. The findings showed there was a significant relationship between the severity of prayer and the demographic variables, such as gender (p < 0.004), education (p < 0.03), and duration of the disease (p < 0.001). The findings also showed that there was a relationship between self-care and gender (p < 0.001), education (p < 0.004), and duration of disease (p < 0.001). Also, the findings showed that there is a relationship between self-care and prayer (r = 727), so that increasing the amount of prayer will increase self-care. The mean (SD) of total prayer is 167.33 (10.49) and total self-care is 35.86 (10.60). With the increase in the rate of praying, their self-care increased. Based upon this, religious interventions are recommended to be held for this group of patients, focusing on praying.

Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study.

OBJECTIVES: Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home. METHOD: Interviews were conducted with 12 patients with severe HF (New York Heart Association class IIIâ€"IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis. RESULTS: Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities. CONCLUSIONS: Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population. TRIAL REGISTRATION NUMBER: NCT01304381; Results.

Religious beliefs and well-being and distress in congestive heart failure patients.

Religiousness (typically assessed as service attendance) is often associated with well-being and psychological distress in persons with life-threatening illnesses, but little of this work has focused explicitly on religious beliefs. We examined the longitudinal relationships of religious beliefs (i.e., in God and in the afterlife) with well-being and distress (assessed 6 months later) in a sample of patients with congestive heart failure, a chronic and progressive disease. After controlling for religious service attendance, belief in God was associated with negative affect and spiritual well-being, while belief in the afterlife was associated with physical health, post-traumatic depreciation, and spiritual well-being. However, after controlling for baseline values of well-being or distress, religious beliefs were not associated with nearly all well-being or distress outcomes at follow-up. Over the 6-month duration of the study, participants increased in belief in afterlife but decreased in their belief in God. Increases in religious beliefs across time were associated with higher levels of distress. These results suggest that religious beliefs are neither positively nor negatively associated with well-being and distress independent of religious attendance among seriously ill patients with CHF. Based on these findings, healthcare providers are encouraged to assess religious belief change at the individual level to better understand and inform spiritual care for patients with late-stage CHF.

Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review.

BACKGROUND: Mindfulness-based interventions may offer a promising approach for promoting psychological and physical health and wellbeing for patients with heart failure. However, the effects of mindfulness-based interventions for this population have not been systematically reviewed. AIMS: This review aimed to synthesise available evidence to assess the effects of mindfulness-based interventions on psychological and physical outcomes and health-related quality of life in patients with heart failure. METHODS: Seven English and two Chinese electronic databases were searched with keywords from inception to May 2019. Experimental studies that examined mindfulness-based interventions in adults with heart failure were eligible for inclusion. Two reviewers independently performed study selection, data extraction and study quality assessment. The results were then narratively synthesised. RESULTS: This review identified five studies involving 467 patients with heart failure. The reviewed studies had weak to moderate quality. There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. The effects on physical function were only measured in one study, with non-significant changes being reported. CONCLUSIONS: This review provides preliminary evidence that mindfulness-based interventions are beneficial for patients with heart failure in reducing depression and anxiety and enhancing health-related quality of life in the short term. These findings should be carefully generalised considering the methodological limitations across studies. More rigorous studies are required to examine further the effects of mindfulness-based interventions in patients with heart failure.

Unique effects of religiousness/spirituality and social support on mental and physical well-being in people living with congestive heart failure.

People living with congestive heart failure (CHF) often experience increasing levels of depressive symptoms and declining quality of life with disease progression. Religiousness/spirituality (R/S) may mitigate these declines, but whether it does so above and beyond provision of social support has not been tested. 191 patients with CHF (64% male; Mage = 68.6 years) completed surveys at baseline and 6 months later. Four mental and physical outcomes were examined: depressive symptoms, positive states of mind, mental health-related quality of life, and physical health-related quality of life. Controlling for demographics and baseline health status, higher levels of spiritual peace and social support each uniquely predicted increased positive states of mind, only social support predicted improved physical health-related quality of life, neither spiritual peace nor social support predicted change in mental health-related quality of life, and only spiritual peace predicted reduced levels of depressive symptoms across 6 months. R/S may play an important role distinct from social support in promoting well-being in people with CHF. Future research should examine the efficacy of attending to patients' R/S and developing interventions towards that end.

Spirituality in heart failure: a review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions.

PURPOSE OF REVIEW: The burden of heart failure is significant and its management is complex. Current evidence confirms a high level of spiritual distress and a strong desire for spiritual support, which is endorsed by healthcare policy, yet spiritual support is rarely provided for this patient group. There is a need to identify how spiritual support might be meaningfully included within holistic heart failure multidisciplinary care and how its effectiveness might be demonstrated. RECENT FINDINGS: A literature review was undertaken to identify recent evidence (2014-2019) of the spiritual care needs of heart failure patients/carers and the nature and effectiveness of spiritual interventions in heart failure care. SUMMARY: Taken as a whole, studies exploring heart failure patients'/carers' needs reflected the broad spectrum of spirituality as defined by international consensus, however, some studies focused on only some aspects of spirituality and on advanced disease. All studies were limited. No single spiritual intervention was identified as effective in enhancing quality of life in patients with heart failure. Life review and relaxation/meditation appeared ineffective. Interventions, which included elements of 'talking' about spiritual matters, 'spiritual coping' and those involving a holistic person-centred team approach to care of which spiritual care was an aspect, are worth investigating further in well designed randomized controlled trials.

A Randomized Study Examining the Effects of Mild-to-Moderate Group Exercises on Cardiovascular, Physical, and Psychological Well-being in Patients With Heart Failure.

PURPOSE: To compare 2 mild-to-moderate group exercises and treatment as usual (TAU) for improvements in physical function and depressive symptoms. METHODS: Patients with heart failure (n = 70, mean age = 66 yr, range = 45-89 yr) were randomized to 16 wk of tai chi (TC), resistance band (RB) exercise, or TAU. RESULTS: Physical function differed by group from baseline to follow-up, measured by distance walked in the 6-min walk test (F = 3.19, P = .03). Tai chi participants demonstrated a nonsignificant decrease of 162 ft (95% confidence interval [CI], 21 to -345, P = .08) while distance walked by RB participants remained stable with a nonsignificant increase of 70 ft (95% CI, 267 to -127, P = .48). Treatment as usual group significantly decreased by 205 ft (95% CI, -35 to -374, P = .02) and no group differences occurred over time in end-systolic volume (P = .43) and left ventricular function (LVEF) (P = .67). However, groups differed over time in the Beck Depression Inventory (F = 9.2, P < .01). Both TC and RB groups improved (decreased) by 3.5 points (95% CI, 2-5, P < .01). Treatment as usual group decreased insignificantly 1 point (95% CI, -1 to 3, P = .27). CONCLUSIONS: Tai chi and RB participants avoided a decrease in physical function decrements as seen with TAU. No groups changed in cardiac function. Both TC and RB groups saw reduced depression symptoms compared with TAU. Thus, both TC and RB groups avoided a decrease in physical function and improved their psychological function when compared with TAU.

Meditation interventions among heart failure patients: An integrative review.

BACKGROUND: There has been growing interest in meditation techniques as an intervention in chronic disease populations. Little is known of the effect meditation practice has on outcomes among patients with heart failure. PURPOSE: To identify and examine current literature on meditation interventions on heart failure outcomes. METHOD: The review utilized methods described by Whittemore and Knafl. Three electronic databases were searched through March 2018. Terms used were "mindfulness OR meditation" and "heart failure" in combination, generating 58 articles after duplicates were removed. After inclusion and exclusion criteria were applied, six studies qualified for review, including four articles with samples from the United States and two with samples from Brazil and Sweden, respectively. RESULTS: Among the six studies in the final sample, the total number of participants was 320 heart failure patients. Interventional design and length varied among the studies, and 20 different dependent variables were identified. This study distinguished four categories of outcome measures with significant findings: psychosocial, biophysical, quality of life and heart failure symptom burden. Compared with controls meditation practice significantly improved depression (p<.05), social support (p<.05), biophysical factors and quality of life (p<.05), in addition to reducing heart failure symptom burden. Across-study comparisons were limited due to variation in intervention definitions and designs. Additionally, the intervention dose and reporting method varied, limiting comparisons. The sample size in five out of six studies was fewer than 50 participants. Over 20 different measures were used across the six studies to measure outcome variables. CONCLUSION: Meditation may offer a patient-driven practice to reduce heart failure symptoms as well as improve psychosocial wellness and quality of life. Future research among heart failure patients should include the following: rigorous definition of meditation interventions, consistency in intervention characteristics, larger controlled trials, and standardized outcome instruments.