Stress reduction, meditation and mindfulness program in patients with chronic Heart failure

INTERVENTION: Behavioural Meditation Mindfulness The intervention consists of a Stress Reduction, Meditation and Mindfulness Program where 8 consecutive weekly meetings lasting 2 hours are held. Patients receive training in coping tools such as resilience, emotional anchoring, acceptance, immunity to change , positivity, gratitude, interpersonal connections and sense of purpose, in addition to mindfulness meditation exercises (conscious breathing meditation, body scan meditation, compassion meditation and reciprocity meditation).Patients in the intervention group (total 13) received support workbook and CD for 40 minutes meditation practice at home. Control group patients (total 18) underwent usual multidisciplinary follow‐up at the Clínica Valente Coração and the National Institute of Cardiology consisting of consultations on nutrition, occupational therapy, nursing, psychology, physical therapy and psychopedagogy CONDITION: Anxiety Disorders Depressive Disorder F00‐F99 Heart failure Heart failure; Stress, Psychological; Sleep Wake Disorders; Depressive Disorder, Anxiety Disorders ; Heart failure ; Anxiety Disorders ; Depressive Disorder ; Stress, Psychological ; Sleep Wake Disorders I00‐I99 Sleep Wake Disorders Stress, Psychological PRIMARY OUTCOME: Impact in perceived Stress (Perceived stress scale PSS‐14), Anxiety (State‐trace anxiety scale), Depression (Beck Depression Inventory‐II) and Mindfulness (Freiburg mindfulness inventory). Significant reduction in Stress Perception Scores by 37.3% and improvement in the score for mindfulness by 10%. Positive trends in reducing anxiety and depression but without statistical significance. SECONDARY OUTCOME: Impact in Quality of life (Minnesota Living with Heart Failure questionnaire), sleep quality ( Pittsburgh Sleep Quality Index), functional capacity (6‐minute walk test), inflammatory (IL1, IL6, TNF‐alfa, RCP and ESR) and neuro‐hormonal (NT‐proBNP, Cortisol, Adrenaline and Noradrenaline) panels. Significant improvement in quality of life by of 40%, in quality of sleep by 35.2%, in functional capacity by 22% and smaller increase in cortisol levels (16% vs 19%), without significant changes in the other biomarkers. INCLUSION CRITERIA: HF NYHA class I or II; literate, owners of an audio device for listening the meditation CD; committed adhering to 8 weeks of the program; with Mini Mental score beyond 16