The Effectiveness of Lifestyle Interventions in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis

Grace W M Walters; Jian L Yeo; Joanna M Bilak; Coral Pepper; Gaurav S Gulsin; Suzanne C Freeman; Laura J Gray; Gerry P McCANN; Emer M Brady

doi:10.1016/j.cardfail.2024.01.015

The Effectiveness of Lifestyle Interventions in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis

J Card Fail. 2024 Feb 29:S1071-9164(24)00046-0. doi: 10.1016/j.cardfail.2024.01.015. Online ahead of print.

Authors

Grace W M Walters¹, Jian L Yeo², Joanna M Bilak², Coral Pepper³, Gaurav S Gulsin², Suzanne C Freeman⁴, Laura J Gray⁴, Gerry P McCANN², Emer M Brady²

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK. Electronic address: grace.walters@live.co.uk.
² Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK.
³ University Hospitals Leicester, Headquarters Level 3, Balmoral Building Leicester Royal Infirmary, Infirmary Square Leicester, Leicestershire, UK.
⁴ Department of Population Health Sciences, University of Leicester, Leicester, UK.

PMID: 38428727
DOI: 10.1016/j.cardfail.2024.01.015

Abstract

Objectives: To perform a network meta-analysis to determine the effectiveness of lifestyle interventions in exercise tolerance and quality of life (QoL) in people with HFpEF.

Methods: Ten databases were searched for randomized controlled trials that evaluated a diet and/or exercise intervention in people with heart failure with preserved ejection fraction until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O_2peak) and Quality of Life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesized data using network meta-analysis.

Results: We identified 13 trials, including a total of 869 participants, and we incorporated 6 different interventions. Improvements in V̇O_2peak compared to controls were seen for all exercise interventions (2.88 [95% CI: 1.36; 4.39] mL/kg/min) for high-intensity interval training (HIIT); 2.37 [95% CI: 1.02; 3.71] mL/kg/min for low-intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95% CI: 0.81; 3.29] mL/kg/min for moderate-intensity continuous training (MICT); 1.94 [95% CI: 0.59; 3.29] mL/kg/min for LIT; 1.85 [95% CI: 0.27; 3.44] mL/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61] mL/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95% CI: -11.05 [-20.55; -1.54] mL/kg/min) significantly improved MLHFQ scores. Network meta-analysis indicated that HIIT was the most effective intervention for improving both V̇O_2peak (mean improvement 2.88 [95% CI: 1.36; 4.39] mL/kg/min, follow-up range, 4 weeks-3 years) and QoL (-14.45 [95% CI: -24.81; -4.10] points, follow-up range, 12-26 weeks) compared to usual care.

Conclusions: This network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL, with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.

Keywords: Heart failure with preserved ejection fraction; exercise tolerance; lifestyle intervention; quality of life.