Effects of Lifestyle-Integrated Active Pursed-Lip Diaphragmatic Breathing Training on the Prognosis of Chronic Heart Failure: A Retrospective Real-World Study

Background: Device-independent, lifestyle-integrated active pursed-lip diaphragmatic breathing (PLDB) may overcome respiratory rehabilitation barriers in chronic heart failure (CHF). This retrospective real-world study evaluated its prognostic association with functional capacity, quality of life (QoL), and major adverse cardiovascular events (MACE). Methods: A total of 58 CHF patients (NYHA II–IV) were categorized by 6-month post-discharge PLDB adherence into a Respiratory Training Group (RTG; n = 20) and Control Group (n = 38). Functional, structural, QoL metrics, and MACE outcomes were analyzed. Results: After 6 months, the RTG demonstrated significant intra-group improvements in 6 min walk test (6MWT) distance (302.00 [243.60, 408.15] m to 386.00 [339.50, 439.00] m, p = 0.006; baseline-adjusted between-group gain: +76.16 m), handgrip strength (p = 0.046), LVEF (p = 0.003), and scores on the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (p = 0.010), and Self-rating Somatic Symptom Scale-China (SSS-CN) (p = 0.004). Post-intervention, the RTG outperformed controls in handgrip strength (p = 0.012), MLHFQ (p = 0.001) and SSS-CN (p = 0.020). The RTG exhibited a significantly lower MACE incidence (5.0% vs. 42.1%, p = 0.003) and superior MACE-free survival (log-rank p = 0.005). Multivariable Cox regression confirmed high PLDB adherence was independently associated with a lower MACE risk (adjusted HR = 0.103, 95% CI: 0.014–0.779, p = 0.028). Conclusions: High adherence to a 6-month lifestyle-integrated PLDB program correlates with clinically meaningful improvements in exercise capacity, cardiac function, and QoL, and is independently associated with a lower risk of short-term MACE in CHF patients.