Sampurna Hriday Shuddhikaran: an interventional health model to improve quality of life in chronic heart failure
Rohit Sane, Milind Hanchate
Madhavbaug Cardiac Rehabilitation Center, Raigad, India
Background: Heart disease is a worldwide problem affecting people in all communities. The burden of cardiovascular disease in India is immense. India will bear 60% of the world's heart disease burden in the next two years and the average age of patients with heart disease is lower among Indian people who belong to the economically productive group. It is not only the lack of resources but also the inability to continue with the costly treatment that further adds to the woes of the patients. Ayurveda has not only proved beneficial in chronic heart failure but also has helped to improve the quality of life of such patients. The objectives of this study were (1) to study the exercise tolerance capacity of the chronic heart failure patient and (2) to study the effect of the Sampurna Hriday Shuddhikaran (SHS) model in improving the exercise tolerance capacity of chronic heart failure patients.
Methods: Novel Ayurveda-based Madhavbaug Ayurvedic Cardiac Rehabilitation Centre (MCRC) protocol that combines a four-pronged intervention of Snehan (oil massage to reduce vascular tone), Swedan and Hrid Dhara (thermal therapy to reduce salt and water retention), and Basti (rectal herbs to increase cardiac contractility) was used in each patient who received twice daily sessions of 90 min each for six consecutive days. Symptomatic patients (age 17–80 years) with congestive heart failure (grade 1–3 of New York Heart Association classification), of either sex, with an ejection fraction more than 25% and who provided written informed consent were included in study. Patients with a history of myocardial infarction in the previous 2 weeks, uncontrollable hypertension (systolic blood pressure ≥180 mm Hg and diastolic blood pressure ≥110 mm Hg), severe hepatic/renal insufficiency, or pregnancy or lactating were excluded. Evaluation parameters used were exercise tolerance capacity (measured by the standard 6-min walk test [6MWT] and improvement in stress test [ST]), improvement in grade of symptoms (GOS), improvement in maximum oxygen uptake (VO2 max), and improvement in metabolic equivalents (METs) taken on day 1 (preintervention) and on day 6 (postintervention).
Findings: A total of 200 patients were evaluated. Mean age = 55±9 years; mean BMI = 24·5±3 kg/m2; pre-existing diabetes mellitus on treatment = 40%; and past history of coronary angiography or bypass = 7%. The mean improvement in exercise tolerance as measured by 6MWT and ST postintervention was 70·6 m in 6 min and 132·1±85·4 s in 9 min (p=0·03), respectively. The corresponding improvement in VO2 max and METs was 3·1±3·44 L/min and 2·23±1·9 METs. Patient symptoms also improved. Vital parameters were stable. No significant adverse events were seen in any patient.
Interpretation: Sampurna Hriday Shuddhikaran using a novel MCRC protocol was effective in improving the exercise tolerance and oxygen uptake in symptomatic chronic heart failure patients, and this improvement was independent of age, sex, and body-mass index. Further studies are required to confirm these results on a large sample size.
Conflicts of interest: The authors have declared no conflicts.
Source: http://content.onlinejacc.org/misc/TL_JACC_1stAsiaPacific_PosterAbstracts.pdf
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