Investigating the Effects of Acupressure on Sleep Quality, Anxiety, and Physiological Indicators in Patients with Heart Failure

The effects of acupressure at points SP6, PC6, and HT7 on sleep quality, anxiety, and physiological indicators in patients with heart failure will be investigated.

A randomized controlled clinical trial with parallel groups, conducted on 76 patients from a convenience sample.

Patients with heart failure referred to Farshchian Educational and Medical Center in Hamadan and Imam Hossein Hospital in Malayer will be randomly assigned to intervention and control groups. For the acupressure intervention, patients will be positioned appropriately, and pressure will be applied gradually and rhythmically with the fingertips at points SP6, PC6, and HT7. The researcher will identify the exact points and apply pressure in a controlled, rhythmic manner, sufficient for participants to feel warmth, heaviness, or numbness in the target area without causing physical discomfort.

Inclusion criteria: 1) Willingness to participate in the study; 2) Signing the informed consent form; 3) Diagnosed heart failure (EF < 40%); 4) Ability to speak and understand Persian. Exclusion criteria: 1) Addiction to alcohol, illicit drugs, or sedative medications; 2) Known speech, hearing, or cognitive impairments; 3) Use of sedative or anti-anxiety medications within the past 24 hours

Intervention group: Patients in the intervention group will receive acupressure at points SP6, PC6, and HT7 twice daily, 30 minutes per session, for three consecutive days. Control group: Patients in the control group will receive superficial pressure at neutral points surrounding the main points, following the same protocol as the intervention group. Primary outcomes: Sleep quality, anxiety levels, and physiological indicators will be assessed in both groups.

Sleep quality, anxiety levels, and physiological indicators

Patients will be allocated in equal numbers to the intervention and control groups using block randomization. To ensure the unpredictability of group assignment, allocation concealment will be performed by a statistical collaborator, and the randomization sequence will remain concealed until the time of intervention. For this purpose, opaque, sealed, and sequentially numbered envelopes containing the random allocation sequence will be used. Accordingly, after generating an appropriate random sequence based on the method described above and according to the study sample size, a number of opaque envelopes will be prepared. Each randomly generated sequence will be recorded on a card, and the cards will be placed sequentially inside the envelopes. To preserve the random sequence, the envelopes will be numbered consecutively on their outer surface. Finally, the envelopes will be sealed and placed in order inside a box. At the start of participant enrollment, based on the order in which eligible participants enter the study, one envelope will be opened sequentially, and the group assignment for that participant will be revealed.

In this study, participants, clinical caregivers, outcome assessors, and the statistical collaborator will be blinded to the allocation of patients to the intervention and control groups. The research collaborator responsible for outcome assessment will conduct evaluations without knowledge of participants’ group assignments. To maintain blinding during data analysis, study data will be provided to the statistical collaborator in a coded format (A: intervention group, B: control group), without revealing the actual group identities. To assess the effectiveness of blinding, at the end of the intervention period, participants will be asked to guess the group to which they were assigned (intervention or control). The success of blinding will then be evaluated and reported by comparing the guesses between groups using appropriate statistical tests.