Effect of functional electrical stimulation on cardiovascular outcomes in patients with chronic heart failure

Abstract

Background/design Functional electrical stimulation of lower limb muscles is an alternative method of training in patients with chronic heart failure (CHF). Although it improves exercise capacity in CHF, we performed a randomised, placebo-controlled study to investigate its effects on long-term clinical outcomes. Methods We randomly assigned 120 patients, aged 71 ± 8 years, with stable CHF (New York Heart Association (NYHA) class II/III (63%/37%), mean left ventricular ejection fraction 28 ± 5%), to either a 6-week functional electrical stimulation training programme or placebo. Patients were followed for up to 19 months for death and/or hospitalisation due to CHF decompensation. Results At baseline, there were no significant differences in demographic parameters, CHF severity and medications between groups. During a median follow-up of 383 days, 14 patients died (11 cardiac, three non-cardiac deaths), while 40 patients were hospitalised for CHF decompensation. Mortality did not differ between groups (log rank test P = 0.680), while the heart failure-related hospitalisation rate was significantly lower in the functional electrical stimulation group (hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.21-0.78, P = 0.007). The latter difference remained significant after adjustment for prognostic factors: age, gender, baseline NYHA class and left ventricular ejection fraction (HR 0.22, 95% CI 0.10-0.46, P < 0.001). Compared to placebo, functional electrical stimulation training was associated with a lower occurrence of the composite endpoint (death or heart failure-related hospitalisation) after adjustment for the above-mentioned prognostic factors (HR 0.21, 95% CI 0.103-0.435, P < 0.001). However, that effect was mostly driven by the favourable change in hospitalisation rates. Conclusions In CHF patients, 6 weeks functional electrical stimulation training reduced the risk of heart failure-related hospitalisations, without affecting the mortality rate. The beneficial long-term effects of this alternative method of training require further investigation.

Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With Acute Heart Failure (ACTIVE‐EMS): Rationale and protocol for a multicenter randomized controlled trial

“…12 EMS is a novel intervention that shows beneficial effects on both physical function and exercise capacity. [14][15][16][17][18] Therefore, we postulated that EMS therapy would be effective in frail elderly AHF patients. In contrast, EMS therapy has some potential to adversely affect the patients.…”

“…It is necessary for AHF patients to achieve and maintain optimal physical function, and exercise therapy is required to maintain physical function in HF patients, especially in frail elderly subjects . EMS is a novel intervention that shows beneficial effects on both physical function and exercise capacity . Therefore, we postulated that EMS therapy would be effective in frail elderly AHF patients.…”

“…There is a great deal of interest in use of electrical muscle stimulation (EMS), which can safely induce muscle contraction without the volitional effort of the patient, as a new training method that does not evoke dyspnea . Previous reports have indicated that lower‐limb EMS therapy can improve muscle strength, exercise capacity, and health‐related QOL and reduce HF‐related hospitalization in chronic HF patients, including elderly patients . More recently, randomized controlled trials (RCTs) have indicated that a short‐term lower‐limb EMS improved muscle strength, exercise capacity, and health‐related QOL in hospitalized HF patients, including few elderly patients .…”

“…Previous reports have indicated that lower-limb EMS therapy can improve muscle strength, exercise capacity, and health-related QOL and reduce HF-related hospitalization in chronic HF patients, including elderly patients 15,16. More recently, randomized controlled trials (RCTs) have indicated that a short-term lower-limb EMS improved muscle strength, exercise capacity, and health-related QOL in hospitalized HF patients, including few elderly patients 17,18.…”

Effects of combined exercise training and electromyostimulation treatments in chronic heart failure: A prospective multicentre study

“…More recently, one study shows that lower limb electrical stimulation reduced the risk of heart failure-related hospitalisations, without affecting the mortality rate at 19 months follow-up. 36 Many data support EMS effects in CHF such as improvement in exercise capacity, leg muscle strength, 9,[11][12][13][16][17][18] vascular function (blow flow and endothelial function, 13,37 an anti-inflammatory action, 14 and beneficial effects on sympathetic nerve activity. 38,39 However, it is important to emphasise the heterogeneity of these studies 19,20 such as diverse EMS protocols (frequency, duration and number of sessions, stimulated muscle), small series of patients and monocentric data.…”