Table 2.
Efficacy of Different Interventions to Improve Quality of Life and Physical Performance or Exercise Capacity Among Older Patients With HF
| Design | Details About the Intervention | Comparator Group | QOL | Physical Function Exercise Capacity |
|
|---|---|---|---|---|---|
| Dietary intervention (56) | RCT | DASH + sodium-restricted diet in patients after discharge from HF hospitaLization (mean age, 71 yrs) | Usual care | Modest statistically insignificant improvement in KCCQ clinical score | Not assessed |
| Weight loss + exercise (57) | RCT (factorial design trial of diet and exercise intervention) | Caloric restriction with a calorie deficit of ~400 kcal/day in patients with chronic stable HFpEF (mean age, 66 yrs) + 1 h supervised exercise 3 times a week for 20 weeks | Diet and/or exercise vs. usual care | Better QOL according to the KCCQ and SF-36 by the diet intervention | Improvement in exercise capacity by both diet (peak VO2 +0.7 MET) and exercise interventions (peak VO2 +0.8 MET) |
| Multidomain rehabilitation (32) | Pilot RCT | Multidomain physical rehabilitation intervention beginning in the hospital for patients with ADHF (mean age, 72 yrs) | Usual care | Better QOL by KCCQ (+5.4 U) | Trends in improvement in SPPB performance (+ 1.1 U) and 6MWD (+23 m) |
| Supervised exercise training (49) | Meta-analysis of RCTs | Supervised moderate-intensity exercise in patients with chronic stable HFpEF | Usual care | Better QOL by MLWHF (−4 U) score | Improvement in exercise capacity (peak VO2 +0.8 MET) |
| Home-based exercise training (51) | Meta-analysis of RCTs | Mild to moderate intensity walking (40%-75% of peak heart rate); strength training and stretch exercises | Usual care | Better QOL (moderate improvement by pooled effect size across different QOL instruments) | Improvement in exercise capacity (peak VO2 +1 MET) |
| Anti-inflammatory agents (IL-1) (44,45) | RCT | Anakinra in patients with chronic stabLe HFpEF (age range, 45 to 46 yrs) and HFrEF (age range, 49 to 68 yrs) | Usual care | No improvement in QOL (DASI and MLWHF scores) | No improvement in peak VO2 |
6MWD = 6-min walk distance; ADHF = acute decompensated heart failure; DASH = Dietary Approaches to Stop Hypertension; DASI = Duke Activity Status Index; HF = heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; IL = interlukin; KCCQ = Kansas City Cardiomyopathy Questionnaire; MET = Metabolic equivalents; MLWHF = Minnesota Living With Heart Failure; QOL = quality of life; peak VO2 = peak exercise oxygen uptake; RCT = randomized controlled trial; SF-36 = 36-item Short-Form Health Survey.