Remote Ischemic Conditioning for Patients With Heart Failure?

Management of patients with heart failure (HF), stemming from ischemic and nonischemic cardiomyopathies, continues to be problematic, despite the inroads made in the pharmacological armamentarium, by implantable cardioverter defibrillators, cardiac resynchronization therapy, and the eventual resort to cardiac transplantation, and left and/or right ventricular assist devices. Both patients with low left ventricular ejection fraction and patients with HF with preserved left ventricular ejection fraction are admitted to the hospital frequently and serially and keep physicians busy, in the acute and outpatient settings, for their management, also prompting them to search for better ways to deal with this worldwide epidemic and its impact on medical resources and financial costs. Following the original studies that first described the concept of remote ischemic conditioning (RIC), this method in the form of preconditioning, perconditioning, and postconditioning has been found to be beneficial in the management of patients with acute myocardial infarction and those undergoing cardiac and noncardiac surgeries and percutaneous coronary interventions. Also recently, RIC has been proposed for the management of hypertension either for patients with prehypertension or mild hypertension or as a supplement to pharmacological management for patients with more severe forms of hypertension. RIC is implemented by inflating a blood pressure (BP) cuff, applying it in the upper arm, to pressures of ∼20 mm Hg greater than the patient’s systolic BP and leaving it inflated for 5 minutes, then doing the same in the other arm, and finally repeating the procedure in the arm in which the first inflation was applied, for a total of 15 minutes. The myriads of effects engendered through the autonomic nervous system or the humoral vascular response, being now under investigation, produce beneficial effects, including improvements in the endothelial function, and have been equated to the salutary effects, resulting from exercise, which could accordingly be viewed as a form of RIC. In turn, exercise has been recommended for patients with HF, irrespective of its severity. Along this reasoning, one wonders whether RIC could be considered in the management of patients with HF. In such a scheme, the patient could use an inexpensive automated BP monitor, first to measure BP in the left arm, then immediately thereafter inflate the BP cuff to a pressure of ∼20 mm Hg and leaving it inflated for 5 minutes, and proceeding as previously described either once or twice a day (this could be determined in pilot therapeutic trials) whenever the patient prefers, although applying RIC before breakfast in the morning and before dinner in the evening may be best (described in the following). A modification of the currently available automated BP monitors, perhaps implementing a stopcock to prevent the automatic deflation of the cuff at will, may suffice to turn it to an automated BP monitor and/or RIC machine. In addition to the potential therapeutic effect of HF with the implementation of RIC (we should all be reminded that we currently do not possess any specific therapy for patients with HF with preserved ejection fraction), a number of benefits to the patients may be realized: (1) empowerment of the patients in implementing their care; (2) checking of the BP (and heart rate) once or twice a day; (3) this may motivate the patients to check their weight daily; (4) this may motivate the patients to be more compliant with their drug regimen; (5) this may motivate the patients to modify their drug regimen in response to their BP, heart rate, and weight (i.e., increasing or decreasing the dose of prescribed medications); (6) this may motivate the patients to keep their clinic appointments; and (7) the patients will learn a lot about their disease, which will ensure an improvement in their communication with health professionals. These are worth a try, considering the current impasse we are experiencing, with the “revolving doors” serial hospital admissions of patients with HF. However, the concept that RIC might work in patients with congestive HF is at this time still a theory that is yet to be tested.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Dec 5, 2016 | Posted by in CARDIOLOGY | Comments Off on Remote Ischemic Conditioning for Patients With Heart Failure?

Full access? Get Clinical Tree

Get Clinical Tree app for offline access