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Randomised pilot study into the effects of low frequency electrical muscle stimulation in advanced heart failure patients

Session Poster session 3

Speaker Stuart Anthony Ennis

Event : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : S A Ennis (Coventry,GB), G Mcgregor (Coventry,GB), T Hamborg (Warwick,GB), H Jones (Liverpool,GB), R Shave (Cardiff,GB), S Singh (Leicester,GB), P Banerjee (Coventry,GB)

Authors:
S A Ennis1 , G Mcgregor1 , T Hamborg2 , H Jones3 , R Shave4 , S Singh5 , P Banerjee1 , 1University Hospitals of Coventry and Warwickshire NHS Trust, cardiac rehabilitation - Coventry - United Kingdom , 2university of Warwick, Warwick Medical School - Warwick - United Kingdom , 3Liverpool John Moores University, Sport and Exercise Science - Liverpool - United Kingdom , 4Cardiff Metropolitan University, School of Sport - Cardiff - United Kingdom , 5University Hospitals of Leicester NHS Trust, cardiac and pulmonary rehabilitation - Leicester - United Kingdom ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 494

Background:  Chronic heart failure patients have limited treatment options and struggle to adhere to exercise training programmes. Low Frequency Electrical Muscle Stimulation (LF-EMS) may have the potential to reduce breathlessness and increase exercise capacity in this cohort.  However, the practical feasibility of a randomised controlled trial (RCT) of LF-EMS in this debilitated population has not been established.

Methods: Using a double blind, randomised study design, 60 severe heart failure patients (New York Heart Association class III-IV) were assigned to 8 weeks (5 x 60 mins per week) of either LF-EMS intervention (4Hz, continuous) or SHAM placebo (skin level stimulation only) of the quadriceps and hamstrings muscles. Participants used the LF-EMS straps at home and were supervised weekly.  Recruitment, adherence and tolerability to the intervention were measured during the trial as well as physiological outcomes (6 minute walk, quadriceps strength, quality of life and physical activity).

Results: 12 (20%) of the 60 patients (4 LF-EMS, 8 SHAM) withdrew.  Reasons for dropout were: deterioration in health (n= 6) family problems (n=2) device implantation (n=1) and found the stimulation intolerable (n=3) Forty One patients (68.3 %), adhered to the protocol for at least 70% of the sessions. The physiological measures indicated improvement in the LF-EMS group in 6 minute walk distance, and quality of life, although not significantly. Conclusion: Chronic heart failure patients can be recruited to and adhere to LF-EMS studies and find it tolerable.  A larger Randomised Controlled Trial (RCT) in the advanced heart failure population is therefore feasible.

Outcome

Time point

LF-EMS

Sham

p-value

6 MWD (m)

[95% CI]

Baseline

264 [222 - 305]

265 [218 - 312]

0.972

8 weeks

288 [242 - 333]

274 [225 - 323]

0.664

20 weeks

263 [214 - 312]

242 [180 - 305]

0.600

Leg strength (N)

[95% CI]

Baseline

218 [183 - 253]

275 [235 - 315]

0.028

8 weeks

209 [176 - 241]

282 [235 - 328]

0.010

20 weeks

182 [143 - 221]

200 [149 - 251]

0.561

QoL (score)

[95% CI]

Baseline

53 [43 - 63]

51 [42 - 60]

0.766

8 weeks

45 [35 - 54]

46 [36 - 56]

0.849

20 weeks

54 [40 - 69]

37 [18 - 56]

0.156

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