Effects of a 20-Minute Mindfulness-Based Breathing Exercise on Dyspnea, Fatigue, and Sleep Quality in Patients With Heart Failure

Heart failure, with a global prevalence of 26 million, is a leading cause of morbidity and mortality. Compared to its corrected incidence, the prevalence of heart failure is expected to rise due to the aging population. Hospital admissions due to heart failure impose a significant socioeconomic burden, especially due to increasing healthcare costs. It is estimated that more than half of the total expenditures related to heart failure are due to hospital admissions, while pharmacotherapy contributes to 18% of the cost.

Heart failure (HF) is a chronic condition that leads to incapacity. Despite significant progress in optimizing pharmacological treatment for HF patients, the personal and social burden of this disease remains characterized by debilitating symptoms and rehospitalizations. Generalized muscle atrophy, including inspiratory muscle atrophy, is often observed in patients with heart failure. Weakness of the respiratory muscles during exercise and activity can lead to fatigue and shortness of breath.

Dyspnea, early fatigue, exercise intolerance, and reduced life expectancy are common symptoms and signs of heart failure, characterized by the inability of the heart to meet the metabolic demands of tissues. In a study conducted on patients with heart failure, the frequency of severe dyspnea was reported as 69%. The mechanism of dyspnea is multifactorial. Dyspnea can exacerbate fatigue by limiting daily activities in HF patients .

Fatigue is also a prototypical symptom of heart failure. In a study, 59% of HF patients reported moderate to severe fatigue. Fatigue is a reflection of muscle hypoperfusion and is an indicator of reduced cardiac output, with its intensity related to depression, muscle dysfunction, and symptoms of anemia. Fatigue is also an independent predictor of increased cardiac readmission and mortality rates in HF patients. It can be explained by clinical factors such as age, anemia, poor sleep quality, reduced exercise capacity, dyspnea, and psychosocial distress.

Changes in sleep patterns in heart failure patients can negatively affect the prognosis of the disease. Pharmacological methods are the most known and frequently used treatments for patients with sleep problems. However, it is also known that long-term use of medications for sleep problems has the potential to cause serious side effects. Therefore, in recent years, non-pharmacological methods are also being utilized to improve sleep quality in individuals with sleep issues.

Non-pharmacological treatments can be beneficial for HF patients. Research evidence shows that non-pharmacological interventions, especially breathing training, have benefits on dyspnea and anxiety in patients with heart failure. For example, a mindfulness-based psychoeducation intervention, which focuses on cognitively separating bodily sensations from stimulated thoughts and emotions, has been shown to significantly reduce anxiety in patients with chronic heart failure and improve their symptoms. Mindfulness involves consciously paying attention to the present moment in a non-reactive way. It has been shown to reduce stress, anxiety, and depression while improving sleep. Although there is growing evidence supporting the application of mindfulness in various chronic diseases, its benefit in reducing dyspnea remains uncertain. However, most of the evidence on the benefits of mindfulness comes from traditional 6-8 week mindfulness programs. Short mindfulness practices, lasting 5-30 minutes, warrant further research. Recent studies have shown that a single 20-minute mindful breathing session significantly reduced dyspnea in patients with chronic lung disease and decompensated heart failure.

Mindful breathing is an exercise that involves paying attention to one's breath without distraction from external or internal experiences. This maneuver has been shown to relieve distress in patients in palliative care and reduce dyspnea in patients with chronic lung disease. A recent study reported that an 8-week mindfulness-based intervention reduced dyspnea, fatigue, and dizziness symptoms in symptomatic congestive heart failure outpatients compared to traditional treatment alone.

Short mindfulness practices require less energy and time from patients and have the potential to create more sustainable habits when practiced regularly. However, evidence for their effectiveness in reducing fatigue is still lacking. A literature review found that there is insufficient research on mindfulness-based breathing exercises for heart failure patients. This study is expected to contribute to the nursing literature. The aim of this study is to determine the effects of a 20-minute mindfulness-based breathing exercise on dyspnea, fatigue, and sleep quality in patients with heart failure.