Can RMT Reduce Prevalence and Burden of Chronic Heart Failure?

It’s no surprise that heart failure is a major health issue that has significant physical as well as financial implications. What you might not know, however, is that there might be options to help reduce the number of people experiencing heart failure as well as the severity of their symptoms. Let’s take a more in depth look at the issues below.

Key Findings

  • Heart failure is a complex clinical syndrome characterized as a chronic disease with acute exacerbations of symptoms, and is associated with respiratory muscle weakness.
  • Prevalence of chronic heart failure (CHF) lies at 5.8 million in the US, with more than 550 000 newly diagnosed cases per year.
  • The estimated economic burden in the US lies at $39 billion per year, with hospitalizations representing the main driver of these costs.
  • Common comorbidities which increase mortality include chronic obstructive pulmonary disease, bronchiectasis, lower respiratory disease, and asthma.
  • Respiratory muscle training (RMT) improves respiratory muscle strength, dyspnea and exercise capacity, tackling CHF and comorbidities.
  • RMT reduces hypertension, an underlying cause of CHF.
  • RMT directly improves clinically relevant cardiac parameters, directly improving one of the physiological causes of CHF.

Patient Impact

RMT improves the symptoms of CHF and its comorbidities, and helps prevent CHF in high risk patient populations.

What is heart failure?

Heart failure is a complex clinical syndrome resulting in the inability of the heart ventricle to fill or eject blood, and is characterized as a chronic disease with acute exacerbations of symptoms. The prevalence of chronic heart failure (CHF) lies at 5.8 million in the US, with more than 550,000 newly diagnosed cases per year (1). The estimated economic burden of heart failure in the US lies at $39 billion per year, with hospitalizations representing the main driver of these costs (2).

Is heart failure a common issue globally?

The global prevalence of heart failure is at an estimated 23 million, indicating that the US carries almost a quarter of the global burden of CHF. Heart failure has now been classified as an emerging epidemic due to a steady increase in diagnosis. The risk of developing CHF during a lifetime lies at 20% to 29% in white men, and is lower in black men and women. At diagnosis, 5-year survival is 50%, while the medium survival recently increased to 1.6 years due to health-care advances. Hospitalization rates are hard to estimate due to a wide range of underlying reasons for hospital admission, many of which might or might not be associated with CHF. In some of these cases, the primary reason for hospitalization might not be accurately recorded as CHF, in which case CHF is not reported as primary cause and will escape statistical evaluation. Estimates place the issue at more than 550,000 hospitalizations per year due to CHF, but the real numbers might be higher and will be rising annually.

What causes heart failure?

The causes of CHF are mainly lifestyle related, with hypertension, smoking, obesity and diabetes mellitus contributing as risk factors. Common comorbidities which increase mortality include chronic obstructive pulmonary disease, bronchiectasis, lower respiratory disease, asthma, and acute renal failure (1),(2).

Can RMT help patients with heart failure?

The effect and potential impact of RMT using the Breather is multifold for CHF. First, patients with CHF usually suffer from respiratory muscle weakness, which greatly contributes to exercise intolerance, peripheral muscle weakness and reduced quality of life. It also contributes to prevalent comorbidities such as COPD and hypertension, which pose a major cause for hospital readmissions among CHF patients, particularly as 68% of patients are readmitted for non-CHF reasons (3). Therefore, the observed increase in respiratory muscle strength caused by RMT impacts on the symptoms of CHF itself while simultaneously tackling comorbidities (4). Second, the proven effect of RMT on hypertension, i.e. lowering systolic and diastolic blood pressure, directly acts on one of the underlying factors of CHF, contributing to CHF prevention (5). Thirdly, RMT directly improves clinically relevant cardiac parameters such as autonomic cardiac control, demonstrating that RMT directly improves one of the physiological causes of CHF (6).

The utilization of RMT using the Breather has great potential to help CHF patients, but also to contribute to disease prevention in high-risk patients, such as those with hypertension. The remote monitoring features of the Breather 2 will increase the impact of RMT in this patient group by increasing compliance, and allow for early intervention upon worsening of symptoms and potential prevention of hospital readmission. Based on the findings that 89% of CHF patients have at least one hospitalization, and that 69% of these patients are readmitted within the next year for both CHF and comorbidity-associated reasons, the multiple impact of the Breather 2 on readmission rates is expected to reduce the economic burden of CHF (3).

References

  1. Roger VL. Epidemiology of Heart Failure. Circulation Research. 2013; 113: 646-659.
  2. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nature reviews Cardiology. 2011;8(1):30-41.
  3. Setoguchi S, Stevenson LW. Hospitalizations in patients with heart failure: who and why. J Am Coll Cardiol. 2009 Oct 27;54(18):1703-5.
  4. Bosnak-Guclu M, Arikan H, Savci S, et al. Effects of inspiratory muscle training in patients with heart failure. Respir Med. 2011 Nov;105(11):1671-81.
  5. Ferreira JB, Plentz RD, Stein C, et al. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: A randomized controlled trial. Int J Card 2013;166(1):61-67
  6. Mello PR, Guerra GM, Borile S et al. Inspiratory muscle training reduces sympathetic nervous activity and improves inspiratory muscle weakness and quality of life in patients with chronic heart failure: a clinical trial. J Cardiopulm Rehabil Prev. 2012 Sep-Oct;32(5):255-61.

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