Effects of Ramadan fasting on the symptoms of chronic heart failure

Rami M. Abazid, Hassan H. Khalaf, Haitham I. Sakr, Nora A. Altorbak, Habiba S. Alenzi, Zaki M. Awad, Osama A. Smettei, Moataz A. Elsanan, Adel M. Widyan, Ahmed S. Azazy, Hassan W. Chamsi-Pasha


Objectives: To investigate the effect of Ramadan fasting on the symptoms of chronic heart failure with a reduced ejection fraction (HFrEF). Globally, more than one billion Muslims fast during Ramadan. Data regarding the effect of fasting in heart failure patients with a reduced ejection fraction are limited.

Methods: We prospectively studied 249 outpatients with HFrEF who undertook Ramadan fasting at tertiary care cardiac center in Saudi Arabia in 2017. We obtained information regarding the clinical assessment, diagnosis, emergency department visits, and hospitalization during and in the month preceding Ramadan.

Results: We enrolled 249 patients, 227 (91%) undertook the fast for the entire month. During Ramadan, 209 (92%) patients remained hemodynamically stable, whereas 18 (8%) developed instability. The mean New York Heart Association (NYHA) functional class was significantly lower in the stable than in the unstable group (1.46±0.7 vs. 3.22±0.55, p less than 0.0001), although no intergroup differences were observed before Ramadan. Patients from the unstable vs. the stable group showed significantly less adherence to medications (67% vs. 94%, p less than 0.0001) and to diet (39% vs. 79%, p less than 0.0001), and a lower likelihood of demonstrating ischemic cardiomyopathy as an underlying etiology of HFrEF (33% vs. 57%, p=0.046). Dependent t-test analysis including all patients showed that the NYHA classification before Ramadan was significantly higher than during Ramadan (2.19±0.9 vs. 1.6±0.8, t-value 8.5, p less than 0.0001).

Conclusion: In most patients with chronic HFrEF, Ramadan fasting is considered safe. Non-adherence to medication and diet are significantly associated with decompensated heart failure during Ramadan.


Saudi Med J 2018; Vol. 39 (4): 395-400
doi: 10.15537/smj.2018.4.22011

How to cite this article:
Abazid RM, Khalaf HH, Sakr HI, Altorbak NA, Alenzi HS, Awad ZM, et al. Effects of Ramadan fasting on the symptoms of chronic heart failure. Saudi Med J. 2018 Apr;39(4):395-400. doi: 10.15537/smj.2018.4.22011.



Ramadan fasting; Islamic; heart failure;

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