New AHA Statement on Complementary Medicine in Heart Failure

There are some potentially serious benefits and risks associated with complementary and alternative medicine (CAM) that patients with heart failure (HF) can use to manage symptoms, the American Heart Association (AHA) says in a new scientific statement on the subject.

For example, yoga and tai chi may be helpful for people with heart failure, and omega-3 polyunsaturated fatty acids may also have benefits. However, there are safety issues with other commonly used over-the-counter (OTC) CAM therapies, including vitamin D, blue cohosh and thrush, the writing group says.

It is estimated that approximately 1 in 3 patients with IC use CAM. But patients often don’t report their use of CAM to their clinician, and clinicians may not routinely ask questions about CAM use or have the resources to evaluate CAM therapies, said the group’s chair. editorial Sheryl L. Chow, PharmD, lecoeur.org | Medscape Cardiology.

“This represents a major public health concern given that consumers frequently purchase these potentially dangerous and poorly regulated products without the knowledge or advice of a medical professional,” said Chow, of Western University. of Health Sciences, Pomona, CA, and the University of California. Irvin.

The 27-page statement was posted online Dec. 8 in Traffic.

CAM Common use in HF

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

“These agents are largely unregulated by the FDA and manufacturers do not need to demonstrate their efficacy or safety. It is important that healthcare professionals and consumers improve communication regarding therapies over-the-counter and be informed of potential efficacy and risk of harm so that shared and informed decision-making can take place,” Chow said.

The writing group reviewed research published before November 2021 on CAM among people with HF.

Omega-3 polyunsaturated fatty acids (PUFAs), such as fish oil, have the strongest evidence among CAM agents for clinical benefit in HF and can be used safely by patients in moderation and in consultation with their healthcare team, according to the drafting group.

Research has shown that omega-3 PUFAs are associated with a lower risk of developing HF as well as improvements in left ventricular systolic function in people with existing HF, they point out.

However, two clinical trials found a higher incidence of atrial fibrillation with the administration of high-dose omega-3 PUFAs. “This risk appears to be dose-related and increases when it exceeds 2 g/d of fish oil,” the writing group says.

Research suggests that yoga and tai chi, when added to standard treatment for HF, can help improve exercise tolerance and quality of life and lower blood pressure.

Inconclusive or potentially harmful CAM therapies

Other CAM therapies for IC have been shown to be ineffective based on current data, have mixed results, or appear harmful. The scripture highlights the following examples:

• Overall evidence regarding the value of vitamin D supplementation in patients with HF remains “inconclusive” and may be harmful when taken with HF medications such as digoxin, calcium channel blockers and diuretics.

• Routine thiamine supplementation in patients with HF and without clinically significant thiamine deficiency may not be effective and should be avoided.

• Research on alcohol varies, with some data showing that drinking low to moderate amounts (one to two drinks a day) can help prevent HF, while habitual drinking or drinking higher amounts is known to contribute to CI.

• The literature is mixed on vitamin E. It may have some benefit in reducing the risk of IC with preserved ejection fraction, but has also been associated with an increased risk of hospitalization for IC.

• Coenzyme Q10 (Co-Q10), commonly taken as a dietary supplement, may help improve HF class, symptoms, and quality of life, but it may also interact with antihypertensive and blood-thinning medications. Co-Q10 remains of “uncertain” value in HF at this time. Large-scale randomized controlled trials are needed before a firm conclusion can be drawn.

• Hawthorn, a flowering shrub, has been shown in some studies to increase exercise tolerance and improve symptoms of IC such as fatigue. Yet it also has the potential to worsen HF, and there is conflicting research as to whether it interacts with digoxin.

• Blue cohosh, an herbal supplement, from the root of a flowering plant found in deciduous forests, may cause tachycardia, high blood pressure, chest pain, and increased heart rate. glycemia. It may also decrease the effect of drugs taken to treat high blood pressure and type 2 diabetes, they note.

• Lily of the valley, the root, stems and flower of which are used in supplements, has long been used in mild HF because it contains active chemicals similar to digoxin. But when taken with digoxin, it can lead to hypokalemia.

In an AHA press release, Chow states, “Overall, more high-quality research and well-powered randomized controlled trials are needed to better understand the risks and benefits” of CAM therapies for HF. .

“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,” adds Chow. .

The writing group encourages healthcare professionals to regularly ask their HF patients about their use of CAM therapies. They also say that pharmacists should be included in the multidisciplinary healthcare team to provide consultation on the use of CAM therapies for patients with HF.

The scientific statement does not include cannabis or traditional Chinese medicine, which have also been used in HF.

In 2020, the AHA published a separate scientific statement on the use of medical marijuana and recreational cannabis on cardiovascular health, as previously reported by lecoeur.org | Medscape Cardiology.

The scientific statement on CAM for HF was prepared by the volunteer writing group on behalf of the AHA Clinical Pharmacology Committee and the Heart Failure and Transplantation Committee of the Clinical Cardiology Board; the Epidemiology and Prevention Council; and the Council on Cardiovascular and Stroke Nursing.

Traffic. Published online December 8, 2022. Summary

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