Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: A prospective randomized study

Objective: We tested whether meditation can reduce sympathetic activation, evaluated by norepinephrine blood levels (NE), and improve quality of life in elderly persons with congestive heart failure (CHF). Design and Setting: This was a prospective, randomized study conducted from April 2000 to October 2001 in an ambulatory care teaching hospital in Sao Paulo, Brazil. Subjects: We studied 19 patients with CHF, 74.8 +/- 6.7 years old, receiving diuretics, optimal doses of an angiotensin-converting enzyme inhibitor or angiotensin 11 inhibitor, maximum tolerated carvedilol dose (23.1 +/- 13.6 mg) and spironolactone 25 mg (10 patients). Interventions: After 2 months of optimal treatment with carvedilol, patients were randomized into two groups. The meditation group (M) was provided an audiotape, 30 minutes long, to listen to at home, twice a day, for 12 weeks, plus a weekly meeting. The control group (C) just had weekly meetings. Main Outcome Measures: We determined before and after 14 +/- 1 weeks, NE (in pg/mL); quality of life with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ); VO2 and VE/VCO2 slope by cardiopulmonary exercise testing; left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVDDi) measured by echocardiography. Results: Meditation reduced NE (mean +/- SEM) from 677.7 +/- 96.6 to 387.1 +/- 39.1 pg/mL (p = 0.008) in M versus 491.4 +/- 35.9 to 470.6 +/- 31.2 (p = 0.34) in C; improved MLWHFQ total score (mean SEM) from 33.2 +/- 6.6 to 21.6 +/- 6.8 points (p = 0.02) in M versus 18.4 +/- 8.0 to 25.1 +/- 8.9 (p = 0.41) in C; and reduced the VE/VCO2 slope (mean SEM) from 31.2 +/- 3.0 to 28.2 +/- 2.6 (p = 0.04) in M versus 28.4 +/- 2.7 to 28.8 +/- 2.6 (p = 0.24) in C. No changes occurred in LVEF, LVDDi, and VO2. Conclusions: In elderly patients with optimally treated CHF, meditation reduced NE, improved quality of life, and reduced the VE/VCO2 slope. Our results support the possible role of meditation as a new hope in the treatment of CHF.