Efficacy and Safety of Acute Phase Intensive Electrical Muscle Stimulation in Frail Older Patients with Acute Heart Failure: Results from the ACTIVE-EMS Trial

Improving Lower Limb Function and Frailty in Frail Older Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention: A Randomized Controlled Study of Neuromuscular Electrical Stimulation

Background

A global public health problem, frailty is closely associated with poor prognosis after percutaneous coronary intervention (PCI) in older patients with acute myocardial infarction (AMI). Although exercise intervention is the most commonly used method to reverse and alleviate frailty, its application is restricted in patients with acute myocardial infarction following PCI due to cardiovascular instability and autonomic imbalance. Consequently, there is a need for a new practical intervention to address frailty syndrome in these patients.

Purpose

This study aimed to investigate the effect of neuromuscular electrical stimulation in frail older AMI patients post-PCI.

Patients and Methods

A single-blind, randomized controlled trial was carried out in the Department of Cardiovascular Medicine from March to October 2023. A total of 100 eligible participants were randomly divided into two groups: experimental (n = 50) and control (n = 50) groups, respectively. Both groups received usual care. The experimental group underwent neuromuscular electrical stimulation (NMES) on bilateral quadriceps and gastrocnemius muscles for 30 minutes daily from day 1 to day 7 after surgery. The primary outcomes measured included the frailty score, lower limb muscle strength, and lower limb muscle quality. Secondary outcomes included the activities of daily living score, inflammatory markers, and length of hospital stay. All participants were included in an intention-to-treat analysis after the study ended.

Results

The frailty scores of the two groups exhibited a gradual decrease over time, and the scores of the experimental group were lower than those of the control group at 4 and 7 days after surgery (P<0.001). Concurrently, the lower limb muscle strength showed an increasing trend over the time in the experimental group and a decreasing trend in the control group, and the scores of the experimental group surpassed those of the control group (p<0.001). Moreover, a statistical difference was observed in the lower limb muscle mass across the groups after 7 days postoperatively compared with baseline on both sides (p<0.05).

Conclusion

Neuromuscular electrical stimulation has the potential to enhance lower limb function and alleviate frailty in elderly patients with acute myocardial infarction after PCI. These findings introduce a novel intervention approach for frailty management in the elderly population.

Non-pharmacological interventions for cognitive impairment in older adults with heart failure: A systematic review

BACKGROUND

Cognitive impairment is a prevalent issue among older adults with heart failure, and non-pharmacological approaches are recommended as the first line of treatment. However, it remains unclear which non-pharmacological interventions are the most effective for achieving optimal cognitive and physical outcomes. The aim of this study is to summarize the available evidence on the impact of non-pharmacological interventions for optimizing cognitive function in older adults with HF.

METHODS

A systematic research was carried out across multiple databases including PubMed, Embase, Scopus, Web of Science, PsycINFO, Cochrane Library, Chinese National Knowledge Infrastructure Database, and Wanfang Database up until May 2022. Randomized controlled trials that focused on non-pharmacological interventions for older adults with heart failure and cognitive impairment, and evaluated the impact on cognitive function were targeted. The risk bias of the selected articles was analyzed following the Cochrane handbook. Two independent reviewers were responsible for selecting the studies, extracting the data, and assessing their quality. The results were reported in a narrative format.

RESULTS

A total of 11 studies, which involved 1,287 patients, were reviewed and showed an acceptable risk of bias. These studies evaluated various cognitive domains, including global cognition, delayed recall memory, working memory, and verbal memory. Non-pharmacological interventions that included cognitive intervention, cognitive training combined with exercise, exercise training, and self-care management, were shown to have a positive impact on cognitive function, physical performance, and depression levels in older adults with heart failure. One study explored the effects of electrical muscle stimulation therapy, but no significant improvement in cognitive abilities was observed.

CONCLUSION

The available evidence for the effectiveness of non-pharmacological interventions for cognitive impairment in older adults with heart failure is limited, and further research with formal outcome measures and longer follow-up periods is necessary to provide more informed recommendations.

Belt Electrode-Skeletal Muscle Electrical Stimulation in Older Hemodialysis Patients with Reduced Physical Activity: A Randomized Controlled Pilot Study

Background: Although patients receiving hemodialysis are more likely to develop metabolic disorders and muscle weakness at an earlier stage than healthy individuals, many older dialysis patients have difficulty establishing exercise habits to prevent these problems. Therefore, we evaluated the use of belt electrode-skeletal muscle electrical stimulation (B-SES), which can stimulate a wider area than conventional electrical muscle stimulation (EMS), to examine its application and safety in older hemodialysis patients as a means to improve lower extremity function without voluntary effort. Methods: This study was a randomized controlled trial (RCT) involving 20 older dialysis patients (>65 years old) with reduced physical activity. The control group received 12 weeks of routine care only and the intervention group received 12 weeks of B-SES during hemodialysis in addition to routine care. The primary endpoint was the 6 min walk test (6MWT) distance, while the Short Physical Performance Battery (SPPB), body composition, Functional Independence Measure (FIM), biochemistry test, and blood pressure/pulse measurements were used as secondary endpoints. Results: As a result of the 12-week B-SES intervention, no increase in creatine kinase or C-reactive protein levels was observed after the intervention in either group, and no adverse events attributed to the B-SES intervention were observed in the intervention group. Furthermore, the intervention group showed a significant improvement in the 6MWT and SPPB scores after the intervention. Conclusions: The results of this study suggest that a 12-week B-SES intervention during hemodialysis sessions safely improves 6MWT distance and SPPB scores in older patients with a reduced level of physical activity.