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Original Articles

Device-Guided Paced Breathing in the Home Setting

Effects on Exercise Capacity, Pulmonary and Ventricular Function in Patients With Chronic Heart Failure: A Pilot Study

Gianfranco Parati, MD; Gabriella Malfatto, MD, PhD; Simona Boarin, MD; Giovanna Branzi, MD; Gianluca Caldara, MD; Alessia Giglio, MD; Grzegorz Bilo, MD; Guido Ongaro, MD; Ariela Alter, PhD; Benjamin Gavish, PhD and Giuseppe Mancia, MD

From the Department of Cardiology (G.Malfatto, S.B., Branzi, G.C., A.G., Bilo, G.O., G.Mancia), S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy; the Department of Clinical Medicine and Prevention (G.P., G.C., A.G., G.Bilo, G.O., G.Mancia), University of Milano-Bicocca, Milan, Italy; and InterCure Ltd (A.A., B.G.), Lod, Israel.

Correspondence to Gianfranco Parati MD, Department of Cardiology, S.Luca Hospital, University of Milano-Bicocca and Istituto Auxologico Italiano, via Spagnoletto, 3 Milan, 20149 Italy. E-mail gianfranco.parati{at}unimib.it

Received February 12, 2008; accepted July 23, 2008.

Background— Regular slow breathing is known to improve autonomic cardiac regulation and reduce chemoreflex sensitivity in heart failure. We explored the acceptability and usefulness of a device for paced slow breathing at the home setting.

Methods and Results— In this open pilot study, 24 patients with chronic heart failure (61% males, mean age, 64±9 years; New York Heart Association class, 2.81±0.01) were randomized to a control group receiving conventional treatment (n=12) or to a group receiving conventional treatment and device-guided paced breathing (n=12). Groups were comparable for age, therapies, and clinical characteristics. They were evaluated at baseline and again after 10 weeks by Doppler echocardiography, pulmonary function, cardiopulmonary stress test, and quality of life (Minnesota Quality of Life questionnaire). The treatment group was instructed to use the equipment for 18 minutes twice daily. The device is a computerized box connected to a belt-type respiration sensor and to headphones; it generates musical tones (based on the user’s breathing rate and inspiration ratio), which guide the user to progressively and effortlessly slow his or her breathing rate <10 breaths/min. The treatment group showed high compliance to the device (90% of the prescribed sessions were completed). Blinded analysis of data demonstrated increased ejection fraction and decreased estimated pulmonary pressure in the echocardiograms of the treated group versus controls and favorable changes in New York Heart Association class, VE/VCO₂, FEV₁, and a quality of life measure, as well (all P<0.05).

Conclusions— This pilot investigation demonstrates that device-guided paced breathing at home is feasible and results in an improvement in clinically relevant parameters for patients with heart failure and systolic dysfunction.

Key Words: heart failure • nervous system, autonomic • respiration • rehabilitation

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CLINICAL PERSPECTIVE