Advertisement

Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial

Published:December 23, 2019DOI:https://doi.org/10.1016/j.cardfail.2019.12.005

      Highlights

      • The outcome of HF patients still remains unsatisfactory due to comorbidities.
      • The introduction of complementary non-pharmacological treatments may improve QOL.
      • Music has beneficial effects on cardiovascular, respiratory, neuroendocrine systems.
      • Listening to recorded classical music is able to improve QOL in HF patients.

      ABSTRACT

      Background

      Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting.

      Methods and Results

      Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P < .001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P < .001 for both), and cognitive performances (P = .003).

      Conclusions

      Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • Bueno H.
        • Clealand J.G.F.
        • Coats A.J.S.
        • et al.
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2220
        • Tanai E.
        • Frantz S.
        Pathophysiology of heart failure.
        Compr Physiol. 2015; 6: 187-214
        • Angermann C.E.
        • Ertl G.
        Depression, anxiety and cognitive impairment: comorbid mental health disorders in heart failure.
        Curr Heart Fail Rep. 2018; 15: 398-410
        • Kwok C.S.
        • Kontopantelis E.
        • Kuligowski G.
        • Gray M.
        • Muhyaldeen A.
        • Gale C.P.
        • et al.
        Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis.
        J Am Heart Assoc. 2018; 7e008552
        • Rutledge T.
        • Reis V.A.
        • Linke S.E.
        • Greenberg B.H.
        • Mills P.J.
        Depression in heart failure: a meta-analytic review of prevalence, intervention effects and associations with clinical outcomes.
        J Am Coll Cardiol. 2006; 48: 1527-1537
        • Zambroski C.H.
        • Moser D.K.
        • Bhat G.
        • Ziegler C.
        Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure.
        Eur J Cardiovasc Nurs. 2005; 4: 198-206
        • Bekelman D.B.
        • Havranek E.P.
        • Becker D.M.
        • Kutner J.S.
        • Peterson P.N.
        • Wittstein I.S.
        • et al.
        Symptoms, depression, and quality of life in patients with heart failure.
        J Card Fail. 2007; 13: 643-648
        • Heo S.
        • Moser D.K.
        • Pressler S.J.
        • Dunbar S.B.
        • Kim J.
        • Ounpraseuth S.
        • et al.
        Dose-dependent relationship of physical and depressive symptoms with health- related quality of life in patients with heart failure.
        Eur J Cardiovasc Nurs. 2013; 12: 454-460
        • Hunt S.A.
        • Abraham W.T.
        • Chin M.H.
        • Feldman A.M.
        • Francis G.S.
        • Ganiats T.G.
        • et al.
        2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.
        Circulation. 2009; 119: 391-479
        • Montinari M.R.
        • Giardina S.
        • Minelli P.
        • Minelli S.
        History of music therapy and its contemporary applications in cardiovascular diseases.
        South Med J. 2018; 2: 98-102
        • Trappe H.J.
        The effects of music on the cardiovascular system and cardiovascular health.
        Heart. 2010; 96: 1868-1871
        • Kliger
        • et al.
        Complementary/integrative therapies that work: a review of the evidence.
        Am Fam Physician. 2016; 94: 369-374
        • Mandel S.E.
        • Hanser S.B.
        • Secic M.
        • Davis B.A.
        Effects of music therapy on health-related outcomes in cardiac rehabilitation: a randomized controlled trial.
        J Music Ther. 2007; 44: 176-197
        • Okada K.
        • Kurita A.
        • Takase B.
        • Otsuka T.
        • Kodani E.
        • Kusama Y.
        Effects of music therapy on autonomic nervous system activity, incidence of heart failure events, and plasma cytokine and catecholamine levels in elderly patients with cerebrovascular disease and dementia.
        Int Heart J. 2009; 50: 95-110
        • Bernardi L.
        • Porta C.
        • Casucci G.
        • Balsamo R.
        • Bernardi R.F.
        • Fogari R.
        Dynamic interactions between musical, cardiovascular, and cerebral rhythms in humans.
        Circulation. 2009; 119: 3171-3180
        • Kimata H.
        Listening to Mozart reduces allergic skin wheal responses and in vitro allergen specific IgE production in atopic dermatitis patients with latex allergy.
        Behav Med. 2003; 29: 1519
        • Nilsson U.
        Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial.
        J Clin Nurs. 2009; 18: 2153-2161
        • Burrai F.
        • Wouabi A.
        • Luppi M.
        • Micheluzzi V.
        A conceptual framework encompassing the psycho-neuro-immuno-endocrinological effects of listening to music in heart failure patients.
        Holist Nurs Pract. 2018; 32: 81-88
        • Seifi L.
        • Najafi Ghezeljeh T.
        • Haghani H.
        Comparison of the effects of benson muscle relaxation and nature sounds on the fatigue in patients with heart failure: a randomized controlled clinical trial.
        Holist Nurs Pract. 2018; 32: 27-34
        • Chang M.Y.
        • Chen C.H.
        • Huang K.F.
        Effects of music therapy on psychological health of women during pregnancy.
        J Clin Nurs. 2008; 17: 2580-2587
        • Bruer R.A.
        • Spitznagel E.
        • Cloninger C.R.
        The temporal limits of cognitive change from music therapy in elderly persons with dementia or dementia-like cognitive impairment: a randomized controlled trial.
        J Music Ther. 2007; 44: 308-328
        • Horne-Thompson A.
        • Grocke D.
        The effect of music therapy on anxiety in patients who are terminally ill.
        J Palliat Med. 2008; 11: 582-590
        • Raglio A.
        • Bellelli G.
        • Traficante D.
        • Gianotti M.
        • Ubezio M.C.
        • Villani D.
        • et al.
        Efficacy of music therapy in the treat- ment of behavioral and psychiatric symptoms of dementia.
        Alzheimer Dis Assoc Disord. 2008; 22: 158-162
        • Fligor B.J.
        • Cox L.C.
        Output levels of commercially available portable compact disc players and the potential risk to hearing.
        Ear Hear. 2004; 25: 513-527
        • Nilsson U.
        The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial.
        Heart Lung. 2009; 38: 201-207
        • Rector T.
        • Kubo S.
        • Cohn J.
        Patients’ self-assessment of their congestive heart failure—part 2: content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire.
        Heart Fail. 1987; 3: 198-209
        • Ware Jr., J.
        • Kosinski M.
        • Keller S.D.
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Buysse D.J.
        • Reynolds III, C.F.
        • Monk T.H.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • Charbonneau S.
        • Whitehead V.
        • Colling I.
        • et al.
        The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Parati G.
        • Malfatto G.
        • Boarin S.
        • Branzi G.
        • Caldara G.
        • Giglia A.
        • et al.
        Device-guided paced breathing in the home setting: effects on exercise capacity, pulmonary and ventricular function in patients with chronic heart failure: a pilot study.
        Circ Heart Fail. 2008; 1: 178-183
        • Ryu M.J.
        • Park J.S.
        • Park H.
        Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.
        J Clin Nurs. 2011; 21: 728-735
        • Barnason S.
        • Zimmerman L.
        • Nieveen J.
        The effects of music interventions on anxiety in the patient after coronary artery bypass grafting.
        Heart Lung. 1995; 24: 124-132
        • Bradt J.
        • Dileo C.
        • Potvin N.
        Music for stress and anxiety reduction in coronary heart disease patients (Review).
        Cochrane Database Syst Rev. 12. 2013CD0065772013
        • Ryu M.J.
        • Park J.S.
        • Park H.
        Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.
        J Clin Nurs. 2012; 21: 728-735
        • Twiss E.
        • Seaver J.
        • McCaffrey R.
        The effect of music listening on older adults undergoing cardiovascular surgery.
        Nurs Crit Care. 2006; 11: 224-231
        • Pauwels E.K.J.
        • Volterrani D.
        • Mariani
        • Kostkiewicks M.
        Mozart, music and medicine.
        Med Princ Pract. 2014; 23: 403-412
        • Chanda M.L.
        • Levitin D.J.
        The neurochemistry of music.
        Trends Cogn Sci. 2013; 17: 179-193
        • Kaye D.
        • Esler M.
        Sympathetic neuronal regulation of the heart in aging and heart failure.
        Cardiovasc Res. 2005; 66: 256-264
        • Koelsch S.
        • Fuermetz J.
        • Sack U.
        • Bauer K.
        • Hoenhadel M.
        • Wiegel M.
        • et al.
        Effects of music listening on cortisol levels and propofol consumption during spinal anesthesia.
        Front Psychol. 2011; 2: 58
        • Stefano G.B.
        • Hartman A.
        • Bilfinger T.V.
        • Magazine H.I.
        • Liu Y.
        • Casares F.
        • et al.
        Presence of the mu3 opiate receptor in endothelial cells: coupling to nitric oxide production and vasodilation.
        J Biol Chem. 1995; 270: 30290-30293
        • Nilsson U.
        Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial.
        J Clin Nurs. 2009; 18: 2153-2161
        • McEniery C.M.
        • Wallace S.
        • Mackenzie I.S.
        • et al.
        Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans.
        Hypertension. 2006; 48: 602-608
        • Stefano G.B.
        • Zhu W.
        • Cadet P.
        • Salamon E.
        • Mantione K.J.
        Music alters constitutively expressed opiate and cytokine processes in listeners.
        Med Sci Monit. 2004; 10: 18-27
        • Suzuki M.
        • Kanamori M.
        • Nagasawa S.
        • Saruhara T.
        Behavioral, stress and immunological evaluation methods of music therapy in elderly patients with senile dementia.
        Nihon Ronen Igakkai Zasshi. 2005; 42: 74-82
        • Bittman B.B.
        • Berk L.S.
        • Felten D.L.
        • Westengard J.
        • Simonton O.C.
        • Pappas J.
        • et al.
        Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects.
        Altern Ther Health Med. 2001; 7: 38-47
        • Hirokawa E.
        • Ohira H.
        The effects of music listening after a stressful task on immune functions, neuroendocrine responses, and emotional states in college students.
        J Music Ther. 2003; 40: 189-211
        • Staricoff R.L.
        • Duncan J.P.
        • Wright M.
        A study of the effects of visual and performing arts in health care.
        Med Sci Monit. 2002; 10: 18-27
        • Kejr A.
        • Gigante C.
        • Hames V.
        • Krieg C.
        • Mages J.
        • Konig N.
        • et al.
        Receptive music therapy and salivary histamine secretion.
        Inflamm Res. 2010; 59: 217-218
        • Wachi M.
        • Koyama M.
        • Utsuyama M.
        • Bittman B.B.
        • Kitagawa M.
        • Hirokawa K.
        Recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees.
        Med Sci Monit. 2007; 13: 57-70
        • Emery C.F.
        • Hsiao E.T.
        • Hill S.M.
        • et al.
        Short-term effects of exercise and music on cognitive performance among participants in a cardiac rehabilitation program.
        Heart Lung. 2003; 32: 368-373