The study, which looked at the survival of people with ALS over the course of 18 months, was published in the June 21, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Researchers also found an omega-6 fatty acid may be beneficial. The omega-omega-6 fatty acid called linoleic acid that is found in vegetable oils, nuts, meats, seeds and eggs was associated with a lower risk of death during the study. The study does not prove that these omega fatty acids slow decline of ALS or extend survival; it only shows an association.

ALS is a rare, progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. People with ALS lose the ability to initiate and control muscle movement, which often leads to total paralysis and death. The average life span after diagnosis is two to five years.

“The link our study found between diet and ALS is intriguing and suggests, but does not prove, that people with ALS may benefit from incorporating more omega-3 fatty acids into their diet,” said Kjetil Bjornevik, MD, PhD, of Harvard University and member of the American Academy of Neurology. “It will now be important to conduct additional research looking specifically at the plant-based omega-3 fatty acid alpha-linolenic acid in people with ALS to further explore this possibility.”

The study involved 449 people who had ALS with an average age of 58, who were followed over 18 months. Of the total participants, 126 or 28%, died by the end of the study.

Researchers looked at levels of omega-3 fatty acids in participants’ blood. They divided them into four groups based on lowest to highest amounts.

Participants took a test to assess their disease progression and severity of symptoms. The test measured 12 aspects of physical function including swallowing, speaking, chewing, and the ability to use muscles in the hands, arms, legs and torso, as well as respiratory function. Each category was scored from zero, meaning no ability, to four, meaning normal ability. Total scores ranged between zero to 48, with higher scores indicating better function and less severe symptoms.

Researchers found an omega-3 fatty acid called alpha-linolenic acid was the most beneficial. This acid is found in many seeds and oils, including flaxseed, walnuts, chia, hemp, and many common vegetable oils.

The people with the highest amount of alpha-linolenic acid had an average score of 38.3 at the start of the study, while the people with the lowest amount had an average score of 37.6.

A lower number of people from the group with the most alpha-linolenic acid died during the study, with 21 deaths, or 19%, compared to people in the lowest group, with 37 deaths or 33%.

After adjusting for age, sex and ethnicity, people with the highest amounts of alpha-linolenic acid had a 50% lower risk of death during the study compared to people with the lowest amount.

Higher levels of a specific omega-3 fatty acid called eicosapentaenoic acid that is found in fatty fish and fish oil supplements was also associated with a lower risk of death during the study.

A limitation of the study is the lack of access to data on the overall diet of the participants, including other nutrients and supplements as well as total caloric intake, which could all be associated with survival time in ALS.

The study was supported by the ALS Association.

A limitation of the study is the lack of access to data on the overall diet of the participants, including other nutrients and supplements as well as total caloric intake, which could all be associated with survival time in ALS.

Learn more about ALS at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health.

Given these findings, older adults on low-dose aspirin and their care providers may want to consider periodic monitoring of red blood cells or hemoglobin, the NIH said in a news release. Anemia in older adults is associated with functional decline, increased fatigue, disabilities, depressive symptoms, and cognition problems.

The study was published in the Annals of Internal Medicine.

Scientists from the Aspirin in Reducing Events in the Elderly (ASPREE) study examined the effect of long-term low-dose aspirin use on incident anemia and the effect of aspirin on changes in hemoglobin concentration, as well as ferritin levels, as an indicator of iron deficiency.

The researchers found that low-dose aspirin led to increased incident anemia in otherwise healthy older adults at enrollment, independent of major bleeding.

Previous ASPREE data analyses suggested daily low-dose aspirin does not decrease risk for dementia and cognitive decline; and that daily low-dose aspirin had no effect on healthy lifespan in older people.

ASPREE, a joint U.S. and Australian research project aimed at determining the effect of low-dose aspirin on survival without dementia or disability, began in 2010 and completed recruitment in 2014. It was a randomized, double-blind, placebo-controlled, primary prevention trial of daily 100 mg of aspirin in a population of healthy older people in the U.S. and Australia with a period of treatment averaging 4.5 years. The trial involving 19,114 people age 65 and older was distinctive for its size, methodological rigor, and high participant retention rate in both countries.

And among people who have chronic pain, almost two-thirds will still have it the following year. These findings come from a new analysis of National Health Interview Survey (NHIS) data by investigators from the National Center for Complementary and Integrative Health (NCCIH), Seattle Children’s Research Institute, and the University of Washington, published in May 2023 in JAMA Network Open.

Previous research has shown that about 18 percent of U.S. adults have chronic pain (pain that has lasted for three months or more). However, not much was known about how chronic pain rates have changed over time. How many people develop new cases of chronic pain each year? How many of those who have chronic pain at one time still have it a year later? And how many recover (i.e., become pain free)? This new analysis used data from the nationally representative NHIS 2019–2020 longitudinal cohort, in which about 10,000 U.S. adults were interviewed on two occasions a year apart, to find answers to these questions.

Among survey respondents who were pain free in 2019, 6.3 percent reported chronic pain in 2020, with an incidence of 52.4 cases per 1,000 persons per year (PY). Compared to other conditions for which the incidence is known for the U.S. adult population, such as diabetes (7.1 cases/1,000 PY), depression (15.9 cases per 1,000 PY), and hypertension (45.3 cases/1,000 PY), this is a high rate.

Among those who reported pain that was not chronic in 2019, 14.9 percent reported chronic pain in 2020. This is more than twice the percentage seen among those who were pain free in 2019 and suggests the importance of early management of acute or otherwise nonchronic pain to decrease the risk that it will become chronic.

According to the researchers among those who reported chronic pain in 2019, almost two-thirds (61.4 percent) also reported chronic pain a year later, showing a high persistence of this condition.

High rates of high-impact chronic pain (chronic pain that substantially limits a person’s life activities) were seen in 2020 among those who had reported either chronic pain or high-impact chronic pain in 2019.

Contrary to the assumption that chronic pain persists indefinitely, some people with chronic pain recovered. Of those who reported chronic pain in 2019, 10.4 percent had fully recovered (were pain free) in 2020.

The survey data showed some differences among population subgroups. People aged 50 or older were more likely to have chronic pain than those aged 18 to 49. Those with a college degree were less likely to have chronic pain than those without one. The incidence of chronic pain did not differ by race or Hispanic ethnicity, but Asian Americans and those of Mexican ancestry were most likely to recover from chronic pain. No gender differences were observed.

The results of this analysis point to the high disease burden of chronic pain in the U.S. adult population and the need for early management of pain to decrease the likelihood that it will become chronic.

The new research was published in May 2023 in Stroke, the peer-reviewed flagship journal of the American Stroke Association, a division of the American Heart Association.

Vein of Galen malformation (VOGM) is a rare prenatal condition in which arteries bringing high-flow, high-pressure blood to the brain from the heart connect directly with one of the main collecting veins deep at the base of the brain, rather than to capillaries that are necessary to slow blood flow and deliver oxygen to surrounding brain tissue. Due to changes in the infant’s vascular physiology during and after the birth process, the high flow in the malformation has an even more serious effect on the heart and brain after birth, putting enormous pressure on the newborn’s heart and lungs. This may lead to pulmonary hypertension, heart failure or other potentially life-threatening conditions. VOGM is most often first seen on a prenatal ultrasound and is definitively diagnosed by MRI during the late second or third trimester of pregnancy.

The researchers performed the in-utero embolization on a fetus with VOGM at 34 weeks and 2 days gestational age, as the first treated patient in a clinical trial that is underway at Boston Children’s Hospital and Brigham and Women’s Hospital, performed with oversight from the U.S. Food and Drug Administration.

“In our ongoing clinical trial, we are using ultrasound-guided transuterine embolization to address the vein of Galen malformation before birth, and in our first treated case, we were thrilled to see that the aggressive decline usually seen after birth simply did not appear. We are pleased to report that at six weeks, the infant is progressing remarkably well, on no medications, eating normally, gaining weight and is back home. There are no signs of any negative effects on the brain,” said lead study author Darren B. Orbach, M.D., Ph.D., co-director of the Cerebrovascular Surgery & Interventions Center at Boston Children’s Hospital and an associate professor of radiology at Harvard Medical School.

Due to premature rupture of membranes during the in-utero embolization, the infant was delivered by induction of vaginal birth two days later. Echocardiography after birth showed progressive normalization of cardiac output. In this case, the newborn did not require any cardiovascular support or surgery following the in-utero treatment and was watched in the natal intensive care unit (NICU) for several weeks after birth because of prematurity before being sent home. During that time, the newborn had a normal neurological exam and showed no strokes, fluid buildup or hemorrhage on brain MRI.

“While this is only our first treated patient and it is vital that we continue the trial to assess the safety and efficacy in other patients, this approach has the potential to mark a paradigm shift in managing vein of Galen malformation where we repair the malformation prior to birth and head off the heart failure before it occurs, rather than trying to reverse it after birth,” Orbach said. “This may markedly reduce the risk of long-term brain damage, disability or death among these infants.”

It is estimated that VOGM, the most common congenital vascular brain malformation, occurs in as many as one in every 60,000 births. The current standard of care for VOGM is treatment after birth with embolization, a catheter-based procedure to close off the direct artery-to-vein connections in the malformation and block the excess blood flow to the brain and heart. However, embolization itself is high risk and is not always successful at reversing heart failure. Additionally, severe brain damage may have already occurred, which may lead to life-long cognitive disabilities and life-threatening conditions for the infant, or even to death.

“The fetal intervention team at Boston Children’s Hospital and Brigham and Women’s Hospital have successfully devised another in utero procedure that may be very impactful in a specific group of patients diagnosed with vein of Galen malformation,” said Gary M. Satou, M.D., FAHA, the director of pediatric echocardiography at UCLA Mattel Children’s Hospital and co-director of the UCLA Fetal Cardiology Program and who was not involved with the study. Satou, a pediatric cardiologist, is past chair of the American Heart Association’s Congenital Cardiac Defects committee of Young Hearts Council and a clinical professor in the department of pediatrics at the David Geffen School of Medicine at UCLA.

“As always, a number of these fetal cases will need to be performed and followed in order to establish a clear pattern of improvement in both neurologic and cardiovascular outcomes,” Satou said. “Thus, the national clinical trial will be crucial in order to achieve adequate data and, hopefully, successful outcomes.”

The procedure was not without its limitations, noted Colin P. Derdeyn, M.D., a neurointerventional radiologist at University of Iowa Health Care who performs VOGM embolizations on neonates and who was not involved with the study.

“The key advance here is to intervene before the physiologic events of birth can cause life-threatening heart failure. There are caveats; one successful case is not enough experience for us to conclude that the risks of this procedure are worth the benefits. Safety issues may crop up in future procedures, and this approach through the veins may not be consistently successful in preventing heart failure. The procedure described here is designed to reduce the flow through the malformation and not to cure it,” said Derdeyn, the Krabbenhoft Professor of Radiology and chair and department executive officer of the department of radiology at the University of Iowa Health Care Carver College of Medicine and a past chair of the American Heart Association’s Stroke Council.

 “However, the positive changes that they observed in utero and after birth – reduction in flow, reduction in size of the draining vein, reversal of the abnormal reversed flow in the aorta – are really encouraging. These are some of the most exciting and surprising aspects of this case report,” he said. “This is pioneering work being done in a very careful and responsible way.”

Primarily plant-based, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) and Mediterranean diets are rich in nutrients important for brain health. The MIND diet features vegetables, especially green leafy vegetables such as spinach, romaine lettuce and kale; berries over other fruit; and beans, nuts, and one or more weekly servings of fish. The Mediterranean diet consists of vegetables, fruit, legumes, nuts, and at least three servings of fish each week. Both diets also include olive oil, whole grains, small amounts of wine, and limit red meat.

Previous research has shown these diets may slow cognitive decline and reduce the risk for Alzheimer’s. In this study, researchers at Rush University Medical Center examined the association of these diets with brain changes linked with Alzheimer’s.

The study involved 581 participants who agreed to donate their brains at death for dementia research. On average, the participants began the study with a first dietary assessment at an average age of 84 years. Annually, for up to more than a decade, they completed questionnaires about the food they ate in various categories. After the participants’ deaths, the researchers examined the donated brains for amyloid plaques and tau tangles, two protein hallmarks of Alzheimer’s.

The researchers also used the questionnaire information to score adherence to the two diets. Higher scores were given to participants who reported eating foods that each diet defined as healthy and reduced scores for unhealthy foods, such as red meat, and high-sugar and high-fat foods.

The brains of participants who had higher diet scores showed fewer signs of Alzheimer’s. This was primarily due to lower levels of amyloid plaques. This trend was not influenced by other lifestyle factors, including physical activity and smoking, or vascular health. There was no correlation between the diet scores and the presence of tangles.

The study’s participants were mostly White, non-Hispanic, and older. Future studies are needed with more diverse populations and to examine how different foods affect the brain and the cellular processes involved, such as inflammation. Nonetheless, the findings suggest that diet is an important lifestyle factor that needs further research as an Alzheimer’s prevention strategy.

In its announcement, the U.S. Preventive Services Task Force (U.S.P. T.) emphasized that their action today is one step short of a final recommendation. But it is rare for a draft recommendation to be reversed.

The panel also said in a news release that it still needs more research to determine whether women with dense breasts should have an additional screening with breast ultrasound or an MRI,

Additionally, the panel said it has still not determined the benefits of mammograms for women older than 75.

It previously recommended that women in their 40s make an individual decision about whether to get screened. This change in recommendation, the panel said, could result in 19 percent more lives being saved.

“New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” said task force immediate past president Carol Mangione, M.D., M.S.P.H. “This new recommendation will help save lives and prevent more women from dying due to breast cancer.” Mangione is distinguished professor of medicine and public health at the University of California, Los Angeles (UCLA), and the executive vice chair for Health Equity and Health Services Research in the UCLA Department of Medicine

Additionally, the task force said, Black women are 40 percent more likely to die of breast cancer than white women and too often get deadly cancers at younger ages. The group said it “recognizes this inequity” and is “urgently” calling for more research to understand the underlying causes and what can be done to eliminate the dealth disparity.

“Ensuring Black women start screening at age 40 is an important first step, yet it is not enough to improve the health inequities we face related to breast cancer,” says task force vice chair Wanda Nicholson, M.D., M.P.H. Nicholson is a senior associate dean for diversity, equity, and inclusion and professor of prevention and community health at the Milken Institute School of Public Health at the George Washington University. “In our draft recommendation, we underscore the importance of equitable follow up after screening and timely and effective treatment of breast cancer and are urgently calling for more research on how to improve the health of Black women.”  

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

Just 4% of patients with obesity who underwent bariatric surgery developed obesity-associated cancer in a 10-year followup, compared to 8.9% among those who did not have a weight-loss procedure, according to a study to be presented in May 2023 at Digestive Disease Week® (DDW) 2023, a convention of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

“The primary benefit people consider when they think about bariatric surgery is weight loss and the accompanying physical and psychological benefits, such as improved blood pressure and diabetes,” said Dr. Vibhu Chittajallu, the study’s lead author and a gastroenterology fellow at Case Western Reserve University, and University Hospitals. “This study adds to the building evidence that the significant weight loss associated with bariatric surgery may have a protective effect against cancer formation as well.”

The study analyzed records of more than 55,700 patients with obesity who underwent bariatric surgery, comparing them with the same number of similar patients who did not have surgery. Researchers included patients who had sleeve gastrectomy, gastric bypass or gastric band procedures. The investigators controlled for risk factors that play a role in cancer formation, such as smoking history, alcohol use, heart disease and hormone therapies.

In 10 years of follow-up, the number of patients who developed obesity-associated cancers was 2,206 among those who underwent bariatric surgery, compared to 4,960 among those who did not have surgery.

The bariatric surgery cohort had consistently lower numbers of new cases for virtually all types of obesity-related cancer, including breast (501 vs. 751), colon (201 vs. 360), liver (969 vs. 2,198), pancreas (54 vs. 86), ovarian (130 vs. 214) and thyroid (154 vs. 175).

“We need more research to understand how bariatric surgery affects cancer risk, but the significant findings from this [research] suggest it’s an exciting avenue for further study,” Chittajallu said.

According to a news release from the FDA, Narcan (generic name Naloxone) is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose. The approval, given in March 2023, paves the way for the life-saving medication to reverse an opioid overdose to be sold directly to consumers in places like drug stores, convenience stores, grocery stores and gas stations, as well as online.

The timeline for availability and price of Narcan is determined by the manufacturer. The FDA’s news release said it could be months before the drug is completely switched from prescription status to OTC availability. Other formulations and dosages of naloxone will remain available by prescription only.

Drug overdose persists as a major public health issue in the United States, with more than 101,750 reported fatal overdoses occurring in the 12-month period ending in October 2022, primarily driven by synthetic opioids like illicit fentanyl.

“The FDA remains committed to addressing the evolving complexities of the overdose crisis. As part of this work, the agency has used its regulatory authority to facilitate greater access to naloxone by encouraging the development of and approving an over-the-counter naloxone product to address the dire public health need,” said FDA Commissioner Robert M. Califf, M.D. “[The] approval of OTC (over the counter) naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.” Narcan nasal spray was first approved by the FDA in 2015 as a prescription drug.

In accordance with a process to change the status of a drug from prescription to nonprescription, the manufacturer provided data demonstrating that the drug is safe and effective for use as directed in its proposed labeling. The manufacturer also showed that consumers can understand how to use the drug safely and effectively without the supervision of a healthcare professional. The application to approve Narcan nasal spray for OTC use was granted priority review status and was the subject of an advisory committee meeting in February 2023, where committee members voted unanimously to recommend it be approved for marketing without a prescription.

The approval of OTC Narcan nasal spray will require a change in the labeling for the currently approved 4 mg generic naloxone nasal spray products that rely on Narcan as their reference listed drug product. Manufacturers of these products will be required to submit a supplement to their applications to effectively switch their products to OTC status. The approval may also affect the status of other brand-name naloxone nasal spray products of 4 mg or less, but determinations will be made on a case-by-case basis.

An AHA scientific statement is an expert analysis of current research and may inform future guidelines. The new statement, “Interpreting Incidentally Identified Variants in Genes Associated with Heritable Cardiovascular Disease,” suggests next steps to determine whether a variant truly carries a health risk, provides support to health care professionals on how to communicate with people and their families, and suggests appropriate follow-up actions to care for people with variants deemed higher risk for CVD.

Variants associated with cardiovascular disease risk are often found “incidentally” when people undergo genetic testing for non-cardiac reasons, including screening or diagnosis of other diseases. These unexpected genetic variants may also be discovered with genetic testing through direct-to-consumer DNA testing kits.

Pretest genetic counseling is strongly encouraged to prepare patients for the possibility of incidental findings, how and whether findings will be communicated, and potential implications for themselves and family members.

“The scope and use of genetic testing have expanded greatly in the past decade with the increasing ease and reduced cost of DNA sequencing,” said Andrew P. Landstrom, M.D., Ph.D., FAHA, chair of the scientific statement writing committee and associate professor of pediatrics and cell biology at Duke University School of Medicine in Durham, North Carolina. “Where we would once look for genetic changes in a handful of genes, we can now sequence every gene and, potentially, the whole genome, allowing us to make genetic diagnoses that would have been impossible in the past. However, with increased genetic testing comes more surprises, including finding unexpected variants in genes that might be associated with cardiovascular disease. Landstrom’s remarks are part of an AHA news release.

“If we interpret these incidental variants incorrectly, it may lead to inappropriate care, either by suggesting patients have a risk of cardiac disease when they do not, or by not providing care to those with increased risk for a serious condition.”

This statement is the first to focus on inherited monogenic, or single-gene, diseases for CVD which can be passed on within families, such as hypertrophic cardiomyopathy or long QT syndrome. There are currently 42 clinically treatable, secondary variant genes that increase the risk of sickness or death from sudden cardiac death, heart failure and other types of cardiovascular disease, according to the American College of Medical Genetics and Genomics. Genetic variants that cause long QT syndrome cause the heart to electrically reset slower than normal after each contraction, which may cause electrical instability of the heart and may lead to fainting, arrhythmias or even sudden death.

Once an incidental genetic variant for CVD is found, the statement authors suggest a framework for interpreting the variant and determining whether it is classified as benign, uncertain or pathogenic (disease-causing):

Health care professionals should only relay information to patients about incidentally identified variants if they are among the cardiovascular disease genes already known to be associated with CVD and if patients agreed during pretest genetic counseling to be informed about incidental findings.

Incidentally identified variants in genes with an uncertain association with CVD should not be reported.

If the discovered variant may increase the risk of CVD, a family history and medical evaluation by an expert health care professional are suggested, preferably a specialist working with or within a multidisciplinary team to address in the disease in question. The goal of this evaluation is to determine whether the individual has evidence of the disease, such as symptoms or relevant test results, or if there are any warning signs in the family history.

The genetic variant itself should be re-evaluated periodically by an expert or expert team to ensure whether the CVD link remains accurate. As knowledge about a variant evolves over time, its link to disease may be reclassified.

Finally, the medical evaluation and genetic re-evaluation should guide next steps, which may vary from dismissing the incidental variant as not likely to cause CVD to starting medical interventions. This may also involve periodic re-evaluation with appropriate tests (echocardiogram, blood tests, etc.) and possibly screening other family members for the variant.

“The list of incidental variants related to cardiovascular disease continues to evolve,” Landstrom said. “This statement provides a foundation of care that may help people with a CVD-related genetic variant and their health care professionals take the next step in determining the individual and familial risk that a variant may or may not carry. It’s also important to consult with genetics specialists to custom-tailor an evaluation and treatment plan to both the individual and the genetic variant in order to ensure the highest level of care possible.”

Heart failure is a progressive condition in which the heart is unable to pump enough blood to the body either due to the heart muscle stiffening or from it losing pumping strength. Treatments are focused on reducing symptoms, such as shortness of breath and fatigue, and minimizing or delaying the consequences of the condition, which includes decreased quality of life; frequent hospitalizations; loss of functional independence; high health care costs; and increased risk of death.

According to a news release from the AHA, the statement represents a review of the latest evidence-based research to better understand the potential impact of supervised exercise therapy for the more than three million people in the U.S. living with chronic, stable heart failure with preserved ejection fraction or HFpEF. This condition occurs when the heart is stiff and does not relax normally to fill with enough blood to pump to the body, yet the heart muscle is still strong enough to pump well. In comparison, heart failure with reduced ejection fraction occurs when the left ventricle can’t pump with the force needed to push enough blood into circulation. In the U.S., heart failure with preserved ejection fraction is one of the most common forms of heart failure, with women disproportionately affected compared to men, according to the scientific statement.

“The prevalence of heart failure with preserved ejection fraction continues to increase due to aging of the population and the growing prevalence of risk factors such as obesity and Type 2 diabetes,” said Vandana Sachdev, M.D., chair of the scientific statement writing committee. “Improved management of this large population of patients who have HFpEF, many of whom may be undertreated, represents an urgent unmet need.” Sachdev was quoted in the AHA news release.

Sachdev is a senior research clinician and the director of the Echocardiography Laboratory in the Division of Intramural Research at the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health, as well as the scientific lead for the new NHLBI heart failure program HeartShare.

In April 2022, recommendations were released by the AHA and the ACC for supervised exercise training for people with heart failure, regardless of the type. Sachdev clarified that, currently, Medicare only reimburses cardiac rehabilitation for people with heart failure with reduced ejection fraction (HFrEF).

“Exercising helps improve the heart’s pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle,” Sachdev said. “Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have HFpEF than most medications.”

Members of the writing committee critically examined research published since 2010 to assess the most current data on the impact of exercise-based therapies for HFpEF.

The studies evaluated various types of exercise, including walking, stationary cycling, high-intensity interval training, strength training and dancing in both facility settings and home-based training. Supervised exercise therapy generally occurred three times per week for each of the studies, and the duration of the programs varied from one month to eight months.

In the studies, researchers measured peak oxygen uptake, which is a way to assess exercise capacity by measuring the total amount of oxygen a person can breathe into the lungs during physical exertion. For people living with HFpEF, their peak oxygen uptake is often about 30% lower than that of a healthy person and considered below the threshold required for functional independence (and performing normal daily living activities such as carrying groceries).

The statement writing committee determined that supervised exercise training may lead to:

Increased peak oxygen uptake 12-14% — an increase of more than 6-7%, is considered clinically meaningful.

Increased total exercise time by 21% — a 10% increase is considered clinically meaningful.

Improved quality-of-life scores on the Minnesota Living with Heart Failure questionnaire by 4–9 points. The questionnaire has 21 items, each scored on a 0-5 scale. Total score is derived from adding the scores from each item.

The statement acknowledges there were variations in the baseline characteristics of people in the trials reviewed. Some of the studies excluded patients with some co-existing health conditions, and many groups of people in whom heart failure is prevalent — including older adults, women, persons with low socioeconomic status and people from diverse racial and ethnic groups — were under-represented in some research. Additionally, many of the studies were smaller, single-center studies, and most were relatively short term, so there isn’t enough information to assess long-term adherence, which the committee suggests should be addressed in future research.

“Overall, we did find that in people with chronic, stable heart failure and preserved ejection fraction, supervised exercise training is safe and provides substantial improvements in exercise capacity and quality of life,” Sachdev added. “Future work is needed to improve referral of appropriate patients to supervised exercise programs, and better strategies to improve long-term adherence to exercise training is needed. Hybrid programs combining supervised and home-based training may also be beneficial. Further, implementation efforts will need to include coverage by Medicare and other insurers.”

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association and the American College of Cardiology. It is endorsed by the Heart Failure Society of America; the American Association of Cardiovascular and Pulmonary Rehabilitation; and the American Association of Heart Failure Nurses.

Copyright American Heart Association