Complementary and alternative therapies for heart failure have potential benefits and risks

According to a new scientific statement from the American Heart Association published today in the Association’s flagship, peer-reviewed journal Traffic.

An estimated 6 million people ages 20 and older in the United States suffer from heart failure, a condition that occurs when the heart does not function normally. The statement, “Complementary and Alternative Medicines in the Management of Heart Failure,” assesses the efficacy and safety of CAM therapies used for the treatment of heart failure. According to the statement, it is estimated that more than 30% of people with heart failure in the United States use complementary and alternative medicine.

The statement defines complementary and alternative medicine therapy as medical practices, supplements, and approaches that do not meet the standards of conventional evidence-based practice guidelines. Complementary and alternative products are available without a prescription or medical advice from pharmacies, health food stores and online retailers.

These products are not federally regulated and they are available to consumers without having to demonstrate their efficacy or safety to meet the same standards as prescription drugs. People rarely tell their healthcare team about their use of supplements or other alternative therapies unless specifically requested, and they may not be aware of the possibility of interactions with prescription drugs or other effects on their health. The combination of unregulated and easily accessible therapies and the lack of patient disclosure creates the potential for significant harm. »

Chair of the Scientific Statement Editorial Board Sheryl L. Chow, Pharm.D., FAHA, Associate Professor of Pharmacy Practice and Administration at Western University of Health Sciences in Pomona, Calif., and Professor Clinician Fellow of Medicine at the University of California at Irvin

Examples of complementary and alternative therapies that heart failure patients might use include supplements such as Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil’s claw, alcohol, aloe vera and caffeine, or practices such as yoga and tai chi. The statement writing group reviewed research published before November 2021 on CAM in people with heart failure.

The statement writing group advises healthcare professionals to ask their patients with heart failure at every healthcare visit about their use of complementary and alternative therapies and to discuss potential drug interactions, benefits and effects. potential secondaries of the MCA. Additionally, they suggest that pharmacists be included in the multidisciplinary health care team to provide consultation on the use of complementary and alternative therapies for people with heart failure.

Alternative therapies that may benefit people with heart failure include:

• Omega-3 polyunsaturated fatty acids (PUFAs, fish oil) have the strongest evidence among complementary and alternative agents for clinical benefit in people with heart failure and can be used safely, in moderation, in consultation with their healthcare team. Omega-3 PUFAs are associated with a lower risk of developing heart failure and, for those who already have heart failure, with improvements in the pumping ability of the heart. There appears to be a dose-related increase in atrial fibrillation (an irregular heartbeat), so doses of 4 grams or more should be avoided.
• Yoga and tai chi, in addition to standard treatment, can help improve exercise tolerance and quality of life and lower blood pressure.

Meanwhile, some therapies have been shown to have harmful effects, such as interactions with common heart failure medications and changes in heart contraction, blood pressure, electrolytes, and fluid levels:

• Although low blood levels of vitamin D are associated with more serious heart failure outcomes, supplementation has not shown benefit and may be harmful when taken with heart failure medications such as digoxin, calcium channel blockers and diuretics.
• Bluegrass herbal supplement, from the root of a flowering plant found in deciduous forests, can cause rapid heartbeat called tachycardia, high blood pressure, chest pain, and can increase blood sugar levels. It may also decrease the effect of medicines taken to treat high blood pressure and type 2 diabetes.
• Lily of the valley, the root, stems and flower of which are used in supplements, has long been used in mild heart failure because it contains active chemicals similar to but less potent than the heart failure drug digoxin. cardiac. It can be harmful when taken with digoxin by causing very low potassium levels, a condition known as hypokalemia. Thrush can also cause irregular heartbeats, confusion, and fatigue.

Other therapies have been shown to be ineffective based on current data, or have mixed results, highlighting the importance for patients to have a discussion with a healthcare professional about any non-prescribed treatment:

• Routine thiamine supplementation has not been shown to be effective for the treatment of heart failure unless someone has this specific nutrient deficiency.
• Research on alcohol varies, with some data showing that drinking low to moderate amounts (1-2 drinks per day) is associated with preventing heart failure, while habitual drinking or drinking higher amounts is toxic to heart muscle and known to contribute to heart failure.
• The results for vitamin E are mixed. It may have some benefits for reducing the risk of heart failure with preserved ejection fraction, a type of heart failure in which the left ventricle is unable to properly fill with blood between heartbeats. However, it has also been associated with an increased risk of hospitalization in people with heart failure.
• Co-Q10, or coenzyme Q10, is an antioxidant found in small amounts in organ meats, fatty fish, and soybean oil, and commonly used as a dietary supplement. Small studies show it may help improve heart failure class, symptoms, and quality of life, however, it may interact with blood thinners and blood pressure medications. Larger trials are needed to better understand its effects.
• Hawthorn, a flowering shrub, has been shown in some studies to increase exercise tolerance and improve heart failure symptoms such as fatigue. Yet it also has the potential to worsen heart failure, and there is conflicting research as to whether it interacts with digoxin.

“Overall, more high-quality research and well-powered randomized controlled trials are needed to better understand the risks and benefits of complementary and alternative medicine therapies for people with heart failure,” Chow said. “This scientific statement provides essential information for healthcare professionals who treat people with heart failure and can be used as a resource for consumers about the potential benefits and harms associated with complementary and alternative medicine products.”