Biofeedback May Offer a New Restorative Therapy for Heart Failure Patients

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Biofeedback is now finding another focus—heart disease, the leading cause of death in the US.

Biofeedback – Biofeedback is now finding another focus—heart disease, the leading cause of death in the US. Drs. Christine Moravec and Michael McKee of the Cleveland Clinic have tested the potential of biofeedback to improve autonomic nervous system balance in patients with end-stage heart failure. Theirs is the first study to measure the impact of biofeedback training on actual heart muscle function.

An article in the journal Biofeedback discusses a pilot study of biofeedback training in heart failure patients awaiting transplantation. The training seeks to improve autonomic balance, thus providing a non-invasive and cost-effective means to treat patients with heart failure.

Through biofeedback training, an individual can be taught to control the autonomic nervous system, which includes the sympathetic and parasympathetic branches. With injury or disease of the heart, the sympathetic branch is over-activated because the heart has to compensate by pumping harder and faster. In patients with heart failure, the role of the parasympathetic branch, which normally has greater control over baseline cardiac function, is diminished. Typical treatments include beta-adrenergic blocking drugs, pacemakers, and implantable pumps called left ventricular assist devices, as well as heart transplantation.

The patients in this pilot study were sicker than those used in previous studies, were on the list for heart transplant, and many were hospitalized or unable to leave home. Twenty completed biofeedback training, and most reported it to be a beneficial experience. Patients learned to regulate their breathing and reduce their heart rate, and some were able to regulate skin conductance and muscle tension. The patients’ “heart rate variability” (the variability of the time between heartbeats, measured in milliseconds), increased into a healthier range for many patients—showing that some cardiovascular resilience remains even at this late stage of disease and is capable of recovery.

In this pilot study, researchers were also able to examine the explanted failing hearts of 12 transplant recipients when the patients received a new heart. These hearts showed some promising “remodeling.” Some reversal of the cellular and molecular changes accompanying heart failure was evident after patients had been treated with a program of biofeedback training. This is the first time that data have shown a non-invasive, non-pharmacologic intervention can not only improve heart patients’ quality of life and functioning, but can lead to reversal of biologic changes in the heart tissue.

A randomized clinical trial, the INNOVATE trial, is currently under way, assessing the safety and efficacy of direct electrical vagal nerve stimulation for heart failure. The trial will include 650 patients from 80 international sites. If INNOVATE is successful, it will validate the therapeutic potential of improving autonomic balance in treating heart failure and will help to support a large clinical trial of biofeedback, a benign and low-cost intervention.

Full text of the article, “Psychophysiologic Remodeling of the Failing Human Heart,” Biofeedback, Vol. 41, No. 1, 2013, is available at

About Biofeedback
Biofeedback is published four times per year and distributed by the Association for Applied Psychophysiology and Biofeedback. AAPB’s mission is to advance the development, dissemination, and utilization of knowledge about applied psychophysiology and biofeedback to improve health and the quality of life through research, education, and practice. For more information about the association, see

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Taylor Fulton
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