von Haehling, Stephan and Arzt, Michael and Doehner, Wolfram and Edelmann, Frank and Evertz, Ruben and Ebner, Nicole and Herrmann-Lingen, Christoph and Macedo, Tania Garfias and Koziolek, Michael and Noutsias, Michel and Schulze, P. Christian and Wachter, Rolf and Hasenfuss, Gerd and Laufs, Ulrich (2021) Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials. EUROPEAN JOURNAL OF HEART FAILURE, 23 (1). pp. 92-113. ISSN 1388-9842, 1879-0844
Full text not available from this repository. (Request a copy)Abstract
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and - with less certainty - testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSITIVE AIRWAY PRESSURE; OBSTRUCTIVE SLEEP-APNEA; PRESERVED EJECTION FRACTION; ADAPTIVE SERVO-VENTILATION; LEFT-VENTRICULAR FUNCTION; MINIMAL IMPORTANT DIFFERENCE; SKELETAL-MUSCLE; ATRIAL-FIBRILLATION; DARBEPOETIN-ALPHA; LONG-TERM; Heart failure; Exercise capacity; Quality of life |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Petra Gürster |
| Date Deposited: | 09 Apr 2021 09:02 |
| Last Modified: | 09 Apr 2021 09:02 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44583 |
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