Lifestyle Modification in Heart Failure Management: Are We Using Evidence-Based Recommendations in Real World Practice?

Abstract

The heart failure (HF) guideline’s purpose is to assist medical professionals while treating patients with HF in accordance with the best current research. Many cases of HF are both, avoidable and treatable thanks to scientific trials. Management is, therefore, based on lifestyle changes, also called non-pharmacological treatment. These, based on lifestyle changes, should be recommended in every patient at risk for HF or with diagnosed of HF, but evidence in itself is scarce. DASH Diet could be clearly beneficial while Mediterranean diet doesn't have enough evidence at the present moment. Smoking should be stopped, and excessive amounts of alcohol drinking avoided, but there is no clinical trial nor registry performed on these aspects. A moderate salt restriction is better than a strict reduction. Exercise and cardiac rehabilitation are beneficial but there are no clear recommendations about type, duration, etc. Most of the evidence that we have in HF patients with obesity is contradictory. Finally, due to the high number of aged frail patients in HF lifestyle changes should be individualized, but again available data is scant. Therefore, due to the lack of current evidence, these gaps need to be considered and need new efforts on investigation in the next future.

Heart Failure With Preserved Ejection Fraction and Frailty: From Young to Superaged Coexisting HFpEF and Frailty

“…Of note, these pathologies are characterized by the presence of low-grade systemic inflammation, oxidative stress, dysregulation of the neuro-hormonal system and metabolic dysfunction settling the basis for maladaptive cardiac remodeling and impaired function, and/or resulting in individual’s multisystem dysregulations, depletion of physical, cognitive reserve, and poor tolerance to stress, substantially leading to the development of frailty and HFpEF. 72 73 74) …”

Optimization of guideline-directed medical treatment for heart failure patients with reduced ejection fraction

“…Only a small pilot study reported that a fluid restriction group experienced fewer typical HF symptoms, greater thirst distress, and stable heart-related quality of life [ 83 ]. To further investigate the effects of fluid restriction in HF patients, a planned RCT called Fluid REStriction in HF vs. liberal fluid UPtake (FRESH-UP) aims to determine whether fluid restriction to < 1.5 L contributes to symptom improvement in New York Heart Association class II or III symptomatic HF patients [ 81 , 84 ].…”

“…The 2021 European Society of Cardiology guidelines discourage the consumption of > 5 g of salt per day to help manage HF. While there is a consensus on avoiding excessive salt intake, the evidence regarding the benefits of strict salt restriction (< 2 g/d) for reducing death or hospitalization in HF patients is not consistent [80][81][82]. In fact, one RCT showed that a group consuming 2-3 g of salt per day had a numerically lower risk of death compared to one consuming < 2 g [80].…”

Exercise Training With Chronic Heart Failure

“…Lifestyle changes also can help manage CHF and improve quality of life. These changes include losing weight (if needed), physical activity/exercise, consuming less sodium (salt), managing substance abuse, and managing stress levels (2,3).…”