A systematic review and meta-analysis of randomized controlled trials on the effects of neuromuscular electrical stimulation in patients with acute heart failure

Background Acute heart failure often leads to impaired physical function, high rehospitalization rates, and poor quality of life. Although exercise-based rehabilitation benefits chronic heart failure patients, its feasibility in acute heart failure is limited. Neuromuscular electrical stimulation offers a potential alternative by safely inducing muscle contractions without causing dyspnea. Methods The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42023453116). Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library, and Embase was conducted up to October 13, 2025. Randomized controlled trials comparing neuromuscular electrical stimulation to control treatments in patients with acute heart failure were included. Data synthesis was performed using Review Manager 5.4. Results Seven randomized controlled trials, with methodological quality ranging from fair to excellent (Physiotherapy Evidence Database (PEDro) scores 5–9), were included. Pooled data analysis revealed that neuromuscular electrical stimulation significantly improved 6-min walking distance (mean difference = 69.92 m, 95% confidence interval CI [32.17–1 07.68], p = 0.0003), quality of life (standardized mean difference = 1.53, 95% CI [1.03–2.03], p < 0.00001), and showed preliminary evidence of improvement in leg muscle strength (standardized mean difference = 0.77, 95% CI [0.25–1.29], p = 0.004), whereas no significant difference was observed in left ventricular ejection fraction (mean difference = 1.94%, 95% CI [−3.91 to 7.79], p = 0.52). Neuromuscular electrical stimulation was generally well tolerated, with no serious adverse events directly attributable to the intervention. Conclusion Neuromuscular electrical stimulation was noted to be effective for improving physical capacity and quality of life in patients with acute heart failure. It offers a promising option for patients unable to engage in conventional rehabilitation. Further large-scale, multicenter Randomized Controlled Trials (RCTs) are needed to confirm these findings.