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One-Year Cardiovascular Prognosis of the Randomized, Controlled, Short-Term Heart Rate Variability Biofeedback Among Patients with Coronary Artery Disease

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Abstract

Purpose

Heart rate variability biofeedback (HRV-BF) is an effective psychophysiological intervention, with short-term effects of increased autonomic nervous system homeostasis, strengthened baroreflex sensitivity, and decreased hostility in patients with coronary artery disease (CAD). The study examined the 1-year HRV-BF effect on cardiovascular prognosis of these patients.

Methods

Of 222 patients with CAD referred by cardiologists, 210 were screened and randomly assigned to the HRV-BF and control groups. All patients received psychophysiological assessment and completed psychological questionnaires at pre- and post-interventions and 1-year follow-up. The cardiovascular prognosis primary endpoints included hospital readmission, emergency revisits, and mortality.

Results

The HRV-BF group had fewer all-cause readmissions (12.00 vs. 25.42%) and all-cause emergency visits (13.33 vs. 35.59%) than the control group. The low-frequency HRV in the HRV-BF group increased at post-intervention and 1-year follow-up compared with that at pre-intervention. Although no significant interaction effect was found in the standard deviation of the normal-to-normal intervals (F = 2.96, p = 0.055), it increased by 26.68% from pre- to post-intervention and 15.77% from pre-intervention to follow-up in the HRV-BF group. However, it decreased by 3.60% from pre- to post-intervention and increased by 1.99% from pre-intervention to follow-up in the control group. Depression and hostility scores decreased significantly at post-intervention and 1-year follow-up only in the HRV-BF group.

Conclusions

The long-term HRV-BF effect was confirmed by improved cardiovascular prognosis, increased cardiac autonomic homeostasis and baroreflex sensitivity, and decreased depression and hostility. HRV-BF is an effective psychophysiological intervention with short- and long-term effects in cardiac rehabilitation programs.

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Acknowledgements

This research was supported by Ministry of Science and Technology, Taiwan (grant number: MOST 103-2410-H-037-005). We would like to thank Professor Pei-Shian Ho for statistical consultations, and cardiologists Dr. Chee-Siong Lee, Dr. Ye-Hsu Lu, Dr. Chih-Sheng Chu, and Dr. Hsuan-Fu Kuo for referring patients to participate this study. We would especially thank student assistants Hsiang-Tzu Huang and Pei-Yun Lin for data collection, and Editage (https://www.editage.com.tw/) for English language editing.

Funding

This study was funded by the Ministry of Science and Technology, Taiwan (grant number: MOST 103-2410-H-037-005).

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Authors and Affiliations

  1. Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan

    Li-Ching Yu, I-Mei Lin & Chin-Lung Chien

  2. Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    I-Mei Lin

  3. Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Sheng-Yu Fan

  4. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Tsung-Hsien Lin

  5. Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Tsung-Hsien Lin

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  1. Li-Ching Yu
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Correspondence to I-Mei Lin.

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Conflict of Interest

I-Mei Lin has received research grant from the Ministry of Science and Technology. The authors declare that they have no conflict of interest.

Human and Animals Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (intuitional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Yu, LC., Lin, IM., Fan, SY. et al. One-Year Cardiovascular Prognosis of the Randomized, Controlled, Short-Term Heart Rate Variability Biofeedback Among Patients with Coronary Artery Disease. Int.J. Behav. Med. 25, 271–282 (2018). https://doi.org/10.1007/s12529-017-9707-7

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  • DOI: https://doi.org/10.1007/s12529-017-9707-7

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