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

According to a new scientific statement released today by the American Heart Association, there are several benefits and potentially serious risks when heart failure patients use complementary and alternative medicine (CAM) to manage their symptoms, so it’s safe. Involvement of the medical team is important forThe association’s flagship, peer-reviewed journal circulation.

An estimated 6 million people over the age of 20 in the United States suffer from heart failure, a condition that occurs when the heart does not function properly. The statement “Complementary and Alternative Medicine in the Management of Heart Failure” evaluates the efficacy and safety of his CAM therapy used to treat heart failure. More than 30% of heart failure patients in the United States are estimated to use complementary and alternative medicine, according to the statement.

This statement defines complementary and alternative medicine therapies as medical practices, supplements, and approaches that do not adhere to the standards of conventional evidence-based practice guidelines. Complementary and alternative products are available at pharmacies, health food stores, and online retailers without a prescription or doctor’s supervision.

These products are not federally regulated and are available to consumers without proof. Effectiveness Or safety that meets the same standards as prescription drugs. People rarely talk to their health care team about using supplements or other alternative therapies unless specifically asked. The combination of unregulated, readily available treatments and lack of patient disclosure creates the potential for significant harm. ”

Sherrill L. Chow, Pharm.D., FAHA, Chair of the Scientific Statements Committee, Associate Professor of Pharmaceutical Practice and Administration, Western Health Sciences College, Pomona, CA, and Associate Clinical Professor, University of California School of Medicine, Irvine

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

The statement-making group encourages health care professionals to ask heart failure patients about the use of complementary and alternative therapies at every visit and to talk about potential drug interactions, benefits, and potential side effects of CAM. Advice. In addition, they suggest that pharmacists be included in multidisciplinary health care teams to provide consultation on the use of complementary and alternative therapies for people with heart failure.

Alternative therapies that may help people with heart failure include the following:

• Omega-3 polyunsaturated fatty acids (PUFAs, fish oils) have the strongest evidence of clinical benefit in heart failure patients among complementary alternatives and should be used safely in moderation and in consultation with your healthcare team. can. Omega-3 PUFAs are associated with a reduced risk of developing heart failure and, for those already with heart failure, associated with improved pumping capacity of the heart. Doses above 4 grams should be avoided as there appears to be a dose-related increase in atrial fibrillation (irregular heart rhythm).
• In addition to standard treatments, yoga and tai chi may help improve exercise tolerance and quality of life and lower blood pressure.

On the other hand, some treatments have been found to have adverse effects, including interactions with common heart failure medications and changes in heart contraction, blood pressure, electrolytes and fluid levels.

• Low blood levels of vitamin D are associated with worse heart failure outcomes, but supplementation has shown no benefit and is co-administered with heart failure medications such as digoxin, calcium channel blockers, and diuretics. It can be harmful.
• Blue cohosh, an herbal supplement derived from the roots of flowering plants found in broadleaf forests, can cause tachycardia, high blood pressure, a rapid heart rate called chest pain, and raise blood sugar levels. It may also reduce the effectiveness of the drug used to treat
• Lily of the valley has long been used for mild heart failure because its roots, stems, and flowers are used in supplements and contain active chemicals similar to, but less potent than, the heart failure drug digoxin. When taken with digoxin, it can be harmful because it causes very low potassium levels, a condition known as hypokalemia.

Other treatments have been shown to be ineffective or have mixed results based on current data, highlighting the importance of patients discussing unprescribed treatments with their healthcare professionals. gender is emphasized.

• Routine thiamine supplementation has not been shown to be effective in treating heart failure unless someone has this particular nutritional deficiency.
• Studies on alcohol vary, with some data suggesting that light to moderate drinking (1 to 2 drinks per day) is associated with heart failure prevention, but habitual or heavy drinking is known to be toxic to and contribute to myocardial toxicity. in heart failure.
• There are various findings about vitamin E. It may have some benefit in reducing the risk of heart failure with preserved ejection fraction, a type of heart failure in which the left ventricle fails to fill properly with blood between beats. It is also associated with an increased risk of patient hospitalization.
• Co-Q10, or coenzyme Q10, is an antioxidant found in small amounts in organ meats, fatty fish, and soybean oil, commonly taken as a dietary supplement. Small studies have shown that it may help improve the class, symptoms and quality of life of heart failure, but it may interact with blood pressure-lowering and anticoagulant medications. Larger trials are needed to better understand the effects.
• Hawthorn, a flowering shrub, has been shown in some studies to increase exercise tolerance and improve heart failure symptoms such as fatigue. There are conflicting studies as to whether

“Overall, more high-quality research and robust randomized controlled trials are needed to better understand the risks and benefits of complementary and alternative medicine therapies for heart failure patients,” said Chow. “This scientific statement provides important information for health professionals treating people with heart failure and may be used as a resource for consumers about the potential benefits and harms associated with complementary and alternative medicine products. there is.”