It is important for people with heart failure to tell their healthcare team, including pharmacists, about any over-the-counter treatments or other therapies, such as herbal supplements or exercise programs, that they are using. in addition to those prescribed by a healthcare professional. .
A recent scientific statement from the American Heart Association summarizes current research on the use of complementary and alternative therapies for the treatment of heart failure.
A new American Heart Association scientific statement recently published in the journal Traffic highlights the potential benefits and risks of using complementary and alternative medicine (CAM) to manage heart failure symptoms.
The statement estimates that more than 30% of people with heart failure in the United States use CAM. The statement highlights the importance of involving the healthcare team in the use of CAM for safety reasons. The American Heart Association estimates that 6 million people aged 20 and older in the United States have heart failure, which occurs when the heart does not function normally.
The statement defines complementary and alternative medicine therapies as medical practices, supplements, and approaches that do not conform to 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 regulated by the federal government and they are available to consumers without having to demonstrate their effectiveness or safety to meet the same standards as prescription drugs,” said Sheryl L. Chow, Pharm.D. , FAHA, chair of the scientific statement writing committee. , associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, California, and clinical associate professor of medicine at the University of California, Irvine. “People rarely tell their healthcare team about their use of supplements or other alternative therapies unless specifically asked, and they may be unaware of the possibility of interactions with prescription medications or other effects on their health. The combination of unregulated and easily accessible therapies and lack of disclosure to patients creates the potential for significant harm.
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 heart failure patients at every medical visit about their use of complementary and alternative therapies and to discuss potential drug interactions, benefits and effects. potential secondary effects of CAM. Additionally, they suggest that pharmacists be included in the multidisciplinary 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 (PUFA, fish oil) have the strongest evidence among complementary and alternative agents for their clinical benefit in people with heart failure and can be used safely, in moderation and 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 an improvement 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.
At the same time, some therapies have been found 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 worse heart failure outcomes, supplementation has shown no benefit and may be harmful when taken with heart failure medications such as digoxin, calcium channel blockers and diuretics.
- The herbal supplement blue cohosh, from the root of a flowering plant found in deciduous forests, may cause a rapid heart rate called tachycardia, high blood pressure, chest pain, and may increase blood pressure. blood sugar. It may also decrease the effectiveness of medications taken to treat high blood pressure and type 2 diabetes.
- Lily of the valley, whose root, stems and flower are used in supplements, has long been used in the treatment of mild heart failure because it contains active chemicals similar, but less potent, to digoxin, a medicine for heart failure. It can be harmful when taken with digoxin by causing very low potassium levels, a condition known as hypokalemia. Thrush can also cause an irregular heartbeat, confusion and fatigue.
Other therapies have been shown to be ineffective based on current data, or have mixed results, highlighting the importance of patients having a discussion with a healthcare professional about any non-prescribed treatments:
- Routine thiamine supplementation has not been shown to be effective for the treatment of heart failure unless a person has this specific nutritional deficiency.
- Research on alcohol varies, with some data showing that drinking low to moderate amounts (1 to 2 drinks per day) is associated with heart failure prevention, while habitual drinking or drinking higher amounts are toxic to the heart muscle and contribute to heart failure.
- Results are mixed regarding 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 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 is commonly taken as a dietary supplement. Small studies show it may help improve heart failure grade, symptoms and quality of life. However, it may interact with anticoagulant and anticoagulant 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 can also worsen heart failure, and research is conflicting about how it interacts with digoxin.
“Overall, more high-quality research and high-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 to healthcare professionals treating people with heart failure and can be used as a resource for consumers on the potential benefits and harms associated with complementary and alternative medicine products.”
Reference: “Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement from the American Heart Association” by Sheryl L. Chow, Biykem Bozkurt, William L. Baker, Barry E. Bleske, Khadijah Breathett, Gregg C . Fonarow, Barry Greenberg, Prateeti Khazanie, Jacinthe Leclerc, Alanna A. Morris, Nosheen Reza, Clyde W. Yancy and on behalf of the Clinical Pharmacology Committee of the American Heart Association and the Heart Failure and Transplantation Committee of the Council clinical cardiology; Council of Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing, December 8, 2022, Traffic.
DOI: 10.1161/CIR.0000000000001110
This scientific statement was prepared by the volunteer writing group on behalf of the Clinical Pharmacology Committee of the American Heart Association and the Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; the Council of Epidemiology and Prevention; and the Cardiovascular Disease and Stroke Nursing Council. The American Heart Association’s scientific statements promote greater awareness of cardiovascular disease and stroke issues and help facilitate informed health care decisions. Scientific statements describe what is currently known about a topic and areas that need further research. Although scientific statements inform the development of guidelines, they do not make treatment recommendations. The American Heart Association Guidelines provide the Association’s official recommendations for clinical practice.
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