Ravi Patel, Emmanuel Kokori, Kathan Trivedi, Amar Patel, Oladipupo Olafiranye
Heart failure (HF) remains a leading cause of global mortality. Remote ischemic conditioning (RIC), a non-invasive technique involving brief episodes of non-lethal limb ischemia and reperfusion, has been investigated as a potential cardioprotective and vascular-conditioning strategy, but its role in chronic HF remains uncertain. This review evaluated the effect of RIC on cardiac biomarkers, coronary microcirculation, left ventricular function, hemodynamics, functional capacity, safety, and clinical outcomes in adults with chronic HF irrespective of etiology. PubMed, Embase, CENTRAL, Web of Science, Scopus, and CINAHL were searched from inception through August 2026 without language restrictions; ClinicalTrials.gov, WHO ICTRP, conference literature, and citation searching were also examined. After deduplication, 966 records were screened. Eight completed studies with outcome data were identified, including seven independent studies with peer-reviewed full-text reports and one abstract-only study, encompassing 215 patients with HF. Small studies reported numerical reductions in BNP/NT-proBNP and selected favorable microvascular, hemodynamic, and ventricular-function findings; however, objective exercise-capacity outcomes were predominantly neutral, and no eligible study was adequately powered to assess mortality or HF hospitalization. The evidence base is limited by small samples, heterogeneous RIC protocols, methodological limitations, risk of bias, and reliance on surrogate endpoints. RIC remains investigational, and larger sham-controlled multicenter trials using contemporary guideline-directed medical therapy and patient-important outcomes are required.