A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure

Abstract

Background Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure. Objective A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure. Methods CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life (QoL). The two authors evaluated study quality, abstracted data elements from each study, and synthesized findings. Results Thirteen articles describing nine unique studies met criteria and were included in the review. Five studies tested relaxation strategies, three tested meditation strategies, and one tested a guided imagery strategy. Seven of the nine studies demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared to attention control or usual care conditions, and reduced pain, dyspnea, fatigue and sleep disturbance within treatment groups (pre- to post-treatment). Symptom-related QoL was improved with meditation compared to attention control and usual care conditions, and improved pre- to post-guided imagery. Conclusions Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings, but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures.

Meditation and Secondary Prevention of Depression and Anxiety in Heart Disease: a Systematic Review

“…Findings of this review are consistent with previous systematic reviews of meditation that have demonstrated small, consistent improvements in anxiety, stress and depression in clinical (Goyal et al, 2014) and chronic illness populations (Gotink et al, 2015); vascular disease (Abbott et al, 2014); and quality of life in heart failure patients (Kwekkeboom & Bratzke, 2015). However, it is difficult to determine meditation efficacy given an unknown dose-response relationship, mechanism of effect and significant heterogeneity within and between study designs (Delaney et al, 2011).…”

Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis

“…[27] We also found that relaxation techniques were effective at improving fatigue symptoms, consistent with a review that evaluated exercise and nonpharmaceutical interventions for CRF and used indirect comparisons to conclude that relaxation was the highest ranked intervention for fatigue reduction. [28] Other systematic reviews have also suggested that relaxation techniques may reduce fatigue in osteoarthritis, [29] heart failure [30] and kidney disease. [31] In contrast to mindfulness and relaxation which were effective at reducing fatigue, acupuncture, massage therapy and energy therapy were not effective.…”

Sleep Disturbance, Daytime Symptoms, and Functional Performance in Patients With Stable Heart Failure

“…For example, cognitive behavioral therapy for insomnia produced large effects on fatigue among HF patients (Redeker et al, 2015), and improved biomarkers of cardiac risk (Carroll et al, 2015; Irwin et al, 2015; Irwin et al, 2014) among a sample of older adults of whom the majority had cardiovascular disorders. Meditation and guided imagery may also be efficacious in improving sleep and sleep-related symptoms among these patients (Kwekkeboom & Bratzke, 2015). Further studies are needed of the extent to which behavioral interventions for insomnia improve symptoms (Conley & Redeker, 2015) and how, in turn, these improvements lead to improved functional performance.…”