Northwestern Medicine Study Shows Acupuncture’s Potential in Improving Outcomes in Cardiac Surgery

CHICAGO -  Acupuncture is a potentially effective treatment for heart rhythm disorders and postoperative symptoms, including pain and nausea, but until now was not studied after cardiac surgery. A pilot clinical trial from Northwestern Medicine’s Bluhm Cardiovascular Institute is the first to study and show the feasibility and benefit of providing daily acupuncture in the hospital setting after open-heart surgery.

Published in JTCVS Open, the Acupuncture After Heart Surgery (ACU-Heart) study found that acupuncture is practical, well-tolerated and has clinical benefit for patients who have undergone heart valve surgery, including lower rates of post-operative atrial fibrillation (POAF).

“Heart surgery is a lifesaving procedure, but it can contribute to physical discomfort and surgical side effects like atrial fibrillation (irregular heartbeat), while also having a psychological impact on the patient” says lead investigator, Kim L. Feingold, PhD, a cardiac psychologist and the founder and director of Cardiac Behavioral Medicine at the Northwestern Medicine Bluhm Cardiovascular Institute at Northwestern Memorial Hospital. “We know that the mind and body are connected, so we’re always looking for ways to improve the patient experience and reduce the emotional consequences of heart disease, which can include depression and anxiety.”

Acupuncture is a component of traditional Chinese medicine that has been used for more than 2,500 years and is believed to stimulate the nervous system. The practice involves inserting thin needles through the skin at specific points along the body to influence the flow of energy and promote healing. Acupuncture has been shown to have pain-relieving, anti-inflammatory and anti-nausea effects.

In the ACU-Heart pilot trial, consenting patients undergoing valve surgery with no prior history of atrial fibrillation (AFib), were randomly sorted into two groups. One group received standard care after surgery and the other received daily acupuncture intervention from the day after surgery until discharge.

“The acupuncture was delivered to each patient in their hospital room by a licensed acupuncturist from Northwestern Medicine Osher Center for Integrative Health,” explains Dr. Feingold. “The acupuncturists coordinated timing with patients and medical providers to ensure that acupuncture was not disruptive to routine medical care.”

Dr. Feingold says that she and fellow researchers wanted to answer three main questions with the ACU-Heart study:

1. Would patients embrace acupuncture during such a significant event as heart surgery?
2. Is it logistically feasible in a cardiac surgery setting to provide daily acupuncture to patients? 
3. Does acupuncture impact medical outcomes such as AFib and post-surgical symptoms such as pain, nausea, stress and anxiety?

The findings were positive on all three fronts.

“We learned that acupuncture after open heart surgery is feasible in this fast-paced environment — even in the intensive care unit the day after surgery — and was well tolerated by patients with no adverse effects,” says Dr. Feingold. “The majority of patients had no prior history with acupuncture, demonstrating their openness to receive integrative therapies after surgery. Overall, patients reported that it was a pleasant and positive aspect of their cardiovascular surgery recovery.”

She notes that some of the nurses commented that patients were more relaxed and calmer after acupuncture. “In a future study, we can fold in measuring the impact that acupuncture intervention has on the care team,” says Dr. Feingold.

From the study, the research team found that acupuncture after heart surgery was linked to:

• Lower rates of post-operative atrial fibrillation (POAF) by 58%. Patients in the study who received acupuncture had a 14% incidence of POAF compared with 33% in the standard control group.
• Reduced pain, nausea, stress and anxiety. Based on patient reporting, these surgical side effects were reduced with each acupuncture session.
• Less time spent in intensive care. Patients who received acupuncture spent about seven fewer hours in the intensive care unit than study participants who didn’t receive acupuncture.
• A reduced need for antiarrhythmic medication at the time of discharge by 68%. Approximately 10% of patients who received acupuncture were on a heart rhythm medication (amiodarone) at the time of discharge compared to 27% in the standard control group. 

“Atrial fibrillation is the most common arrhythmia impacting patients after heart surgery and comes with the increased risk of stroke, heart failure and abnormal blood pressure. Managing Afib and other postoperative symptoms is a key to achieving good outcomes in cardiac surgery,” says co-investigator Patrick M. McCarthy, MD, cardiac surgeon and executive director of the Bluhm Cardiovascular Institute. “While this is a small study, it shows significant promise and we’re excited by the idea that there’s a potential intervention that’s inexpensive, accessible, low risk and it’s well-tolerated by patients.”

Dr. Feingold and Dr. McCarthy agree that a larger, multicenter trial with patients undergoing a broader range of heart procedures is needed to better understand the impact of acupuncture on the severity and timing of POAF, as well as the post-operative physical and emotional symptoms such as pain, nausea, depression and anxiety.

“It's exciting to demonstrate the potential role of integrative therapies like acupuncture in the cardiovascular setting — including after cardiac surgery,” says Dr. Feingold. “There's more to be done, but the ACU-Heart pilot trial certainly demonstrates significant promise.”

The study was funded through a philanthropic gift from the Malkin Family Foundation and approved by the Northwestern University Institutional Review Board (#STU00201408).

B-ROLL, SOUNDBITES & PHOTOS: https://www.dropbox.com/scl/fo/wl524jvxceyuhcil88lvw/h?rlkey=3l4e4uhrl67ufqdstpy4r1owi&dl=0

STUDY LINK: Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial - JTCVS Open