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New analysis highlights effective nerve stimulation techniques for heart failure treatment

Heart failure Heart failure
Heart failure Heart failure

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Renal sympathetic denervation markedly reduces BNP levels while baroreflex activation therapy significantly improves quality of life in patients with heart failure.

A study led by Ping-Tao Tseng et al. has evaluated the potency of various nerve stimulation and modulation strategies for heart failure, offering fresh insights into which approaches might deliver the greatest clinical benefits.

Researchers conducted a systematic review and frequentist network meta-analysis (NMA), pooling data from randomized controlled trials (RCTs) that explored the impact of various nerve-targeted therapies in patients with heart failure. This method allowed them to directly and indirectly compare multiple interventions within a single statistical framework. The study considered both objective clinical measures (such as brain natriuretic peptide [BNP] serum levels, which reflect cardiac stress) and subjective outcomes (including quality of life and psychosocial functioning). Interventions were categorized based on the nervous system targets and whether they included additional vascular components.

Key findings:

  • Dual-target interventions, those addressing both the autonomic nervous system and vascular structures (like the renal or carotid arteries), were generally more beneficial than interventions limited to autonomic nerves alone.
  • Renal sympathetic denervation (which disrupts overactive sympathetic nerves in the kidneys) was the only intervention substantially linked with a greater reduction in BNP levels when compared to control treatments. Lower BNP levels are typically related to improved heart function and lower cardiac stress.
  • Baroreflex activation therapy, which stimulates baroreceptors in the carotid arteries to promote parasympathetic activity and reduce sympathetic tone, was the only method that showed a prominent improvement in patients' quality of life.
  • Other autonomic interventions, such as vagal nerve stimulation, did not show substantial improvements in the primary outcomes when compared to controls.

These findings suggest that not all nerve modulation approaches are equal, and that targeting the vasculature alongside the autonomic nervous system may be key to achieving meaningful therapeutic outcomes in heart failure patients.

Source:

Heart Rhythm

Article:

Network meta-analysis on efficacy of nerve stimulation or modulation in patients with heart failure

Authors:

Ping-Tao Tseng et al.

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