A 71-year-old man with a history of type 2 diabetes mellitus and morbid obesity developed exertional shortness of breath (SOB) and then resting SOB 5 months earlier after a prolonged viral respiratory infection. After being empirically treated for pneumonia, he was diagnosed with heart failure (HF) with reduced ejection fraction (EF). Coronary angiography had findings of nonobstructive disease. Electrocardiography had findings of sinus rhythm at 90 bpm and QRS 120 msec. Despite taking guideline-directed medical therapy (GDMT) including beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, dapagliflozin, and diuretic agents, his symptoms persist, with significant fatigue and SOB with minimal exertion; he can no longer walk his dogs. He developed hypotension while taking sacubitril/valsartan and switched to lisinopril. His left ventricular EF is currently at 30%.
His cardiologist is considering baroreflex activation therapy (BAT) after discussing all available treatment options. Together, they review the potential benefits, including improved quality of life (QoL), increased exercise tolerance, and the possibility of reducing his HF symptoms.
The correct answer is: B. BAT will decrease sympathetic activity and increase parasympathetic tone, potentially improving his HF symptoms.
BAT works by decreasing sympathetic activity and increasing parasympathetic tone, potentially improving his HF symptoms and QoL.
BAT does not directly increase EF but rather modulates autonomic function, which might indirectly improve his cardiac performance. BAT decreases, not increases, sympathetic activity. Finally, BAT complements rather than replaces GDMT; patients usually continue their medications.
Educational grant support provided by: CVRx, Inc.
To visit the Online Course page for the Baroreflex Activation Therapy (BAT): Optimizing Treatment of HF Grant, click here!
References
- Schäfer AC, Wallbach M, Schroer C, et al. Effects of baroreflex activation therapy on cardiac function and morphology. ESC Heart Fail. 2024;11(5):3360-3367. doi:10.1002/ehf2.14940
- Coats AJS, Abraham WT, Zile MR, et al. Baroreflex activation therapy with the Barostim™ device in patients with heart failure with reduced ejection fraction: a patient level meta-analysis of randomized controlled trials. Eur J Heart Fail. 2022;24(9):1665-1673. doi:10.1002/ejhf.2573
- Abraham WT, Zile MR, Weaver FA, et al. Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction. JACC Heart Fail. 2015;3(6):487-496. doi:10.1016/j.jchf.2015.02.006
- Zile MR, Abraham WT, Weaver FA, et al. Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction: safety and efficacy in patients with and without cardiac resynchronization therapy. Eur J Heart Fail. 2015;17(10):1066-1074. doi:10.1002/ejhf.299
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