Decreased HRV has been consistently associated with increased cardiac mortality and morbidity in HF patients. The aim of this study is to determine if a 6-week course of heart rate variability (HRV) biofeedback and breathing retraining could increase exercise tolerance, HRV, and quality of life in patients with New York Heart Association Class I-III heart failure (HF). Participants (N = 29) were randomly assigned to either the treatment group consisting of six sessions of breathing retraining, HRV biofeedback and daily practice, or the comparison group consisting of six sessions of quasi-false alpha-theta biofeedback and daily practice. Exercise tolerance, measured by the 6-min walk test (6MWT), HRV, measured by the standard deviation of normal of normal beats (SDNN), and quality of life, measured by the Minnesota Living with Congestive Heart Failure Questionnaire, were measured baseline (week 0), post (week 6), and follow-up (week 18). Cardiorespiratory biofeedback significantly increased exercise tolerance (p = .05) for the treatment group in the high (C31%) left ventricular ejection fraction (LVEF) category between baseline and follow-up. Neither a significant difference in SDNN (p = .09) nor quality of life (p = .08), was found between baseline and follow-up. A combination of HRV biofeedback and breathing retraining may improve exercise tolerance in patients with HF with an LVEF of 31% or higher. Because exercise tolerance is considered a strong prognostic indicator, cardiorespiratory biofeedback has the potential to improve cardiac mortality and morbidity in HF patients.
United Network for Organ Sharing (UNOS) updated the heart transplant allocation system in 2018 in an effort to improve waitlist times and better prioritize the sickest candidates. The new allocation system added new statuses 1 through 3 at the top of the waitlist in place of former status 1A, with temporary mechanical support (MCS) including extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and other temporary ventricular and biventricular support associated with the highest two statuses. 1 Other common listing strategies such as high-dose inpatient inotrope use and durable ventricular assist devices (LVAD) became statuses 3 and 4, respectively. Early experiences with the impact of the new allocation system identified an increase in temporary MCS (predominantly IABP) and variable effects on post-transplant survival. [2][3][4][5][6] However, there are limited data about the effects of the new allocation system on waitlist outcomes, 3,6 and specifically, the effects on waitlist outcomes stratified by various transplant listing strategies. Ongoing updates to the UNOS dataset allow for additional follow-up time and analyses of waitlist outcomes based on listing strategy. These
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