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Nonpharmacologic therapy improves functional and emotional status in congestive heart failure
J B Kostis1, R C Rosen, N M Cosgrove
1UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Insights
A multimodal nonpharmacologic intervention improved exercise tolerance, mood, and weight in patients with congestive heart failure. Digoxin improved ejection fraction but not quality of life.
Area of Science:
- Cardiology
- Internal Medicine
- Rehabilitation Medicine
Background:
- Congestive heart failure (CHF) management often involves pharmacologic agents.
- Nonpharmacologic interventions are increasingly explored for CHF patients.
- Optimizing treatment for CHF requires comparing various therapeutic approaches.
Purpose of the Study:
- To compare a multimodal nonpharmacologic intervention against digoxin and placebo in CHF patients.
- To evaluate the effects of these interventions in patients already on angiotensin-converting enzyme inhibitors.
Main Methods:
- A randomized, parallel assignment study with 60 patients (New York Heart Association Class II and III).
- Three groups received: (1) nonpharmacologic therapy (exercise, cognitive therapy, dietary changes), (2) digoxin, or (3) placebo.
- Digoxin levels were monitored; placebo and digoxin were administered double-blind.
Main Results:
- Ejection fraction improved with digoxin (+4.4%) compared to placebo (-3.2%) and nonpharmacologic therapy (-3.2%).
- Nonpharmacologic therapy significantly improved exercise tolerance (+182 s), mood (Beck Depression Inventory, Hamilton Anxiety/Depression scales), and resulted in greater weight loss (-4.37 kg).
- Digoxin did not show corresponding improvements in exercise tolerance or quality of life measures.
Conclusions:
- Nonpharmacologic therapy offers significant benefits for functional capacity, weight management, and mood in CHF patients.
- While digoxin improved ejection fraction, it did not enhance exercise tolerance or overall quality of life.
- This suggests a valuable role for comprehensive nonpharmacologic strategies in CHF management alongside standard care.
Purpose:
To compare the effects of a multimodal nonpharmacologic intervention to digoxin and to placebo in patients with congestive heart failure receiving background therapy with angiotensin-converting enzyme inhibitors.
Design:
Randomized, parallel assignment to three treatment groups of 20 patients with congestive heart failure (New York Heart Association Class II and III).
Intervention:
Nonpharmacologic treatment program included the following: (1) graduated exercise training, three to five times per week; (2) structured cognitive therapy and stress management; and (3) dietary intervention aimed at salt reduction and weight reduction in the overweight. Digoxin was titrated to achieve a blood level between 0.8 and 2.0 ng/ml. Placebo and digoxin were administered in a randomized, double-blind fashion.
Results:
Echocardiographic ejection fraction improved (p < 0.05) in the digitalis group (change = +4.4 +/- 6.5) compared with both placebo (change = -3.2 +/- 3.9) and nonpharmacologic therapy (change = -3.2 +/- 3.9). The nonpharmacologic treatment program was well tolerated by all patients and resulted in significant improvement (p < 0.05) in exercise tolerance (digoxin = +51 +/- 50 s, placebo = +91 +/- 76, nonpharmacologic therapy = +182 +/- 139), as well as Beck Depression Inventory score (digoxin = +1.2 +/- 4.4, placebo = +2.0 +/- 4.2, nonpharmacologic therapy = -5.0 +/- 4.2), Hamilton Scale scores of anxiety (digoxin = +3.0 +/- 6.8, placebo = +6.0 +/- 2.6, nondrug therapy = -5.2 +/- 5.4), and depression (digoxin = +1.0 +/- 4.9, placebo = +5.0 +/- 5.0, nonpharmacologic therapy = -6.6 +/- 10.1). In addition, weight loss was significantly greater with nonpharmacologic therapy (digoxin = +0.32 +/- 1.76 kg; placebo = -1.35 +/- 1.44 kg; nonpharmacologic therapy = -4.37 +/- 4.50 kg) compared with both digoxin and placebo.
Conclusions:
Nonpharmacologic therapy improved functional capacity, body weight, and mood state in patients with congestive heart failure. In contrast, digoxin improved ejection fraction without corresponding changes in exercise tolerance or quality of life.