Mindfulness-based interventions promote psychological health, HRQoL in HF patients

Mindfulness-based interventions (MBIs) help reduce depression and anxiety and improve health-related quality of life (HRQoL) in the short-term among patients with heart failure (HF), according to preliminary evidence of a systematic review.

“Despite considerable clinical and methodological heterogeneity across reviewed studies, this review suggests that MBIs might hold promise as an effective approach for promoting psychological health and HRQoL for patients with HF,” the researchers said.

This systematic review involved searching seven English and two Chinese electronic databases from inception to May 2019 for experimental studies that examined MBIs in adults with HF. Two reviewers independently carried out the selection, data extraction and quality assessment. This was followed by a narrative synthesis of the results.

The search yielded five eligible studies involving 467 patients with HF, with weak to moderate quality. Findings consistently indicated that MBIs could substantially reduce depression (three studies) and anxiety (two studies), as well as enhance HRQoL (two studies) after intervention. [Eur J Cardiovasc Nurs 2019;doi:10.1177/1474515119881947]

However, findings from three studies regarding the effects of MBIs on physical symptoms were inconsistent. In addition, only one study measured the effects of MBIs on physical function, reporting nonsignificant changes.

This review demonstrates that MBIs may significantly reduce depression and anxiety at the completion of intervention and 3- and 6-month follow-up, which are in line with the findings of a systematic review of vascular disease and RCTs (randomized controlled trials) in other heart diseases. [PLoS One 2015;10:e0143843; J Psychosom Res 2014;76:341-351; Int J Yoga 2013;6:111]

A meta-analysis of RCTs also reported mild-to-moderate effects of MBIs on depression and anxiety for patients with chronic conditions. [J Psychosom Res 2010;68:539-544]

The finding of the current review on the positive effects of MBIs on HRQoL was supported by another review in vascular disease and one RCT in cardiac patients who underwent a percutaneous coronary intervention procedure. [J Psychosom Res 2014;76:341-351; J Behav Med 2014;37:135-144]

“This finding has significance because patients with HF have significant impairment in HRQoL due to multiple physical symptoms and reduced cardiac function that may progressively worsen along with the disease trajectory,” the researchers said. [Eur J Heart Fail 2013;15:1113-1121]

A cross-sectional study on the impact of HF on QoL reported that patients with HF, compared with other cardiac and noncardiac conditions, had a lower degree of HRQoL. This is one of the reasons why improving HRQoL of patients with HF is essential and considered a critical aspect of cardiovascular care, according to the researchers. [Eur Heart J 2002;23:1867-1876]

Of note, studies included in the current review were of poor quality; thus, caution is needed when interpreting these findings, they said.

“More rigorous research with the provision of RCT designs, powered sample sizes, valid and sensitive measures and long-term follow-ups is required to explore the effects of MBIs among patients with HF,” the researchers said. “Future studies should consider assessing the level of mindfulness, which may help understand how MBIs contribute to significant benefits for patients with HF.”