Michael G. McKee

Biofeedback in the treatment of heart disease.

Biofeedback is a method of training subjects to regulate their own physiology using feedback from physiologic sensors connected to an output display. Biofeedback-assisted stress management (BFSM) incorporates the physiologic signals with instructions on stress management. The goal of BFSM training is to give subjects the tools to control their own mental and physiologic reactions, leading to improved health and wellness. In cardiovascular disease, overactivation of the sympathetic component of the autonomic nervous system and psychologic stress together negatively affect quality of life and clinical status. BFSM targets both areas. We hypothesize that this intervention can be used in cardiovascular disease to improve clinical status and quality of life, as well as interfere with disease progression. We are conducting trials of BFSM in heart failure and stable coronary artery disease. Preliminary data suggest that use of BFSM by heart failure patients may actually cause cellular and molecular remodeling of the failing heart in the direction of normal. We are comparing the effects of BFSM with usual care in patients with stable coronary artery disease, testing the hypothesis that the intervention will decrease both sympathetic hyperarousal and activation of the inflammatory cascade. Since heart rate variability is abnormal in both cardiovascular disease and depression, and since BFSM has been successfully used to change heart rate variability, we also expect this intervention to have a positive impact on the depression that often accompanies cardiovascular disease.

Psychophysiologic Remodeling of the Failing Human Heart

Autonomic imbalance is a therapeutic target in heart failure patients. Overactivation of the sympathetic branch of the autonomic nervous system has for years been treated with beta-adrenergic blocking drugs, although it cannot be long before invasive therapies such as renal sympathetic denervation, currently being tested for resistant hypertension, make their way to the heart failure arena. Insufficient parasympathetic input to the heart is already being augmented with implanted vagal nerve stimulators. It is our contention that biofeedback training could provide much of the same benefit as these more invasive therapies in improving autonomic imbalance, with the added advantage of increasing patient self-efficacy. This article describes a pilot study of biofeedback training in patients with end-stage heart failure awaiting heart transplantation. It was our goal to show not only that patients would appreciate this training and benefit from it but also that patient-controlled autonomic modulation could actu...

Biofeedback in the treatment of heart failure

Biofeedback training can be used to reduce activation of the sympathetic nervous system (SNS) and increase activation of the parasympathetic nervous system (PNS). It is well established that hyperactivation of the SNS contributes to disease progression in chronic heart failure. It has been postulated that underactivation of the PNS may also play a role in heart failure pathophysiology. In addition to autonomic imbalance, a chronic inflammatory process is now recognized as being involved in heart failure progression, and recent work has established that activation of the inflammatory process may be attenuated by vagal nerve stimulation. By interfering with both autonomic imbalance and the inflammatory process, biofeedback-assisted stress management may be an effective treatment for patients with heart failure by improving clinical status and quality of life. Recent studies have suggested that biofeedback and stress management have a positive impact in patients with chronic heart failure, and patients with higher perceived control over their disease have been shown to have better quality of life. Our ongoing study of biofeedback-assisted stress management in the treatment of end-stage heart failure will also examine biologic end points in treated patients at the time of heart transplant, in order to assess the effects of biofeedback training on the cellular and molecular components of the failing heart. We hypothesize that the effects of biofeedback training will extend to remodeling the failing human heart, in addition to improving quality of life.

Biofeedback Assisted Stress Management in Patients with Lung Cancer: A Feasibility Study

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death for men and women in the United States. NSCLC causes a variety of symptoms which result in significant distress and reduced quality of life for patients. Behavioral and other non-pharmacologic treatment interventions for NSCLC have resulted in improved quality of life, reduced emotional distress, and improved longevity. This study investigates the feasibility and effectiveness of biofeedback assisted stress management (BFSM) to reduce stress in patients with NSCLC. Because of patient dropout, this study was terminated prematurely. Despite this, evaluation of data revealed positive trends, with patients learning to reduce their stress, improve their respiration and heart rate variability, and improve coping. These trends suggest that patients with NSCLC can learn to self-regulate physiology and BFSM may be useful for them, although a less ill patient population may be desirable for future investigations.

IMPACT OF CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICE THERAPY ON DEPRESSION AND ANXIETY

Continuous-flow left ventricular assist devices (CF LVAD) are increasingly used in the therapeutic algorithm for patients with end-stage heart failure (HF). Treated patients show improvements on global health status measures. However, there has been limited investigation regarding the prevalence and