Feasibility of a Remote Heart Rate Variability Biofeedback Intervention for Reducing Anxiety in Cardiac Arrest Survivors: A Pilot Trial

26 Pages Posted: 8 Feb 2023

See all articles by Jeffrey Birk

Jeffrey Birk

Columbia University - Irving Medical Center

Robin Cumella

Columbia University - Irving Medical Center

David Lopez-Veneros

Columbia University - Irving Medical Center

Sachin Agarwal

Columbia University - Division of Hospital and Critical Care Neurology

Ian M. Kronish

Columbia University - Irving Medical Center

Abstract

Background: Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention’s feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress.

Methods: The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV.

Results: Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50%) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80% reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV.

Conclusion: A remotely delivered HRVB intervention was acceptable, feasible, and usable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients’ psychological distress, health behaviors, and autonomic dysfunction may be warranted.

Note:

Funding Declaration: The National Institute of Aging (Award number: P30AG064198) provided financial support for the study. No supporting organization was involved in the study planning, design, implementation, or reporting. Additional support was received from the NIH (Sachin Agarwal: R01-HL153311; Jeffrey Birk R01-HL151850).

Conflict of Interest: None.

Ethical Information: Approval was granted by the Columbia University Irving Medical Center Institutional Review Board (AAAS9001).

Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04589559 (NCT04589559).

Keywords: Heart rate variability biofeedback, Feasibility, cardiac arrest, psychological distress

Suggested Citation

Birk, Jeffrey and Cumella, Robin and Lopez-Veneros, David and Agarwal, Sachin and Kronish, Ian M., Feasibility of a Remote Heart Rate Variability Biofeedback Intervention for Reducing Anxiety in Cardiac Arrest Survivors: A Pilot Trial. Available at SSRN: https://ssrn.com/abstract=4333988 or http://dx.doi.org/10.2139/ssrn.4333988

Jeffrey Birk (Contact Author)

Columbia University - Irving Medical Center ( email )

622 W 168th St
New York, NY 10032
United States

Robin Cumella

Columbia University - Irving Medical Center ( email )

622 W 168th St
New York, NY 10032
United States

David Lopez-Veneros

Columbia University - Irving Medical Center ( email )

622 W 168th St
New York, NY 10032
United States

Sachin Agarwal

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Ian M. Kronish

Columbia University - Irving Medical Center ( email )

622 W 168th St
New York, NY 10032
United States

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