Beyond Guideline-Directed Medical Therapy: Nonpharmacologic Management for Patients With Heart Failure (JACC Heart Failure February 2025)-Article: Beyond Guideline-Directed Medical Therapy: Nonpharmacologic Management for Patients With Heart Failure

Article: Beyond Guideline-Directed Medical Therapy: Nonpharmacologic Management for Patients With Heart Failure

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The state-of-the-art review emphasizes the importance of nonpharmacologic management components in heart failure (HF) treatment, supplementing traditional pharmacotherapy and device therapies. Given the complexity of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), lifestyle interventions are critical for optimizing patient care.

Key nonpharmacologic strategies include:

1. <strong>Diet and Nutrition</strong>: While traditional emphasis has been on sodium and fluid restriction to mitigate congestion, recent studies challenge the broad application of these measures. Emphasis is shifting towards a balanced diet, such as the DASH or Mediterranean diets, supported by dietitian guidance, especially for those with malnutrition or obesity. The EFFORT and PICNIC trials indicate that nutritional intervention can improve outcomes in malnourished HF patients.

2. <strong>Obesity Management</strong>: Weight loss through lifestyle changes is recommended, with GLP-1 agonists and bariatric surgery as options for those with excess adipose tissue. Studies highlight semaglutide's benefits and emphasize a comprehensive weight management strategy.

3. <strong>Exercise and Cardiac Rehabilitation (CR)</strong>: Regular physical activity and structured exercise programs, including resistance training, improve exercise capacity, reduce hospitalization, and enhance quality of life in HF patients. The HF-ACTION study supports CR's benefits, although participation remains low due to logistical and clinical barriers.

4. <strong>Sleep-Disordered Breathing (SDB)</strong>: Addressing SDB, particularly sleep apnea, is crucial as it plays a significant role in HF progression. Continuous positive airway pressure (CPAP) therapy and aerobic exercise are recommended treatments.

5. <strong>Mood Disorders</strong>: Managing depression and anxiety through collaborative care models, cognitive behavioral therapy (CBT), and exercise is crucial due to their high prevalence and adverse impact on HF outcomes.

6. <strong>Substance Use Disorders</strong>: Recommendations include integrating social support and addiction specialist interventions into HF management to address substance use disorder effectively.

These strategies underline the significance of a multidisciplinary and holistic approach, integrating lifestyle modifications with conventional HF treatments, to enhance patient outcomes. Further research is indicated to refine these interventions and their implementation.

Keywords

heart failure

nonpharmacologic management

HFrEF

HFpEF

lifestyle interventions

diet and nutrition

obesity management

cardiac rehabilitation

sleep-disordered breathing

mood disorders