AHA Statement Reviews Benefits, Risks of Alternative Therapies for Heart Failure

The American Heart Association (AHA) shed light on the potential benefits and risks associated with using complementary and alternative medicines (CAM) for heart failure patients in a statement published in Circulation. Moreover, the AHA acknowledged that CAM therapies are widely used by heart failure patients but warned that there is limited scientific evidence to support their efficacy.

Alternative medicines and a stethoscope | Image credit: paulynn | stock.adobe.com

Heart failure is a complex condition that requires comprehensive medical management. Although conventional treatments such as medications, lifestyle modifications, and surgical interventions have proven to be effective, some patients turn to CAM therapies as an alternative or adjunct approach. These therapies include herbal remedies, acupuncture, yoga, meditation, and dietary supplements (ex. Co-Q10, vitamin D, Ginkgo, grapefruit juice, etc.).

Alternative therapies that may benefit heart failure patients include omega-3 polyunsaturated fatty acids such as PUFA and fish oil, yoga, and tai chi. However, other therapies were found to have harmful effects such as interacting with heart failure medications or causing changes in blood pressure, heart contraction, electrolytes, and fluid levels. For example, the herbal supplement blue cohosh may cause tachycardia, chest pain, high blood pressure, and may increase blood glucose. Additionally, it may also decrease the efficacy of blood pressure and diabetes medications. Meanwhile, other therapies have demonstrated to be ineffective based on current data, such as thiamine supplementation, vitamin E, and Hawthorn shrub, amongst others. The Table reviews commonly-used CAM therapies and recommendations based on the AHA statement.

Table. Commonly used CAMs and recommendations based on the AHA

The AHA emphasizes that health care professionals should engage in open conversations with their patients about CAM use. Additionally, they recommend adding pharmacists to the multidisciplinary health care team to offer advice about the use of complementary and alternative medicines for patients with heart failure. It is crucial to assess potential interactions between conventional medications and CAM therapies to avoid adverse effects or reduced efficacy of prescribed treatments.

Furthermore, the AHA highlights the need for more research into CAM therapies for heart failure management. It is important to note that manufacturers are responsible for the purity and safety of their products, but the FDA does not review dietary supplement products for safety and effectiveness before they are marketed. US Pharmacopoeia has set quality standards for pharmaceutical and botanical and dietary supplements, but many dietary supplements have not received this designation. Rigorous clinical trials are necessary to determine their safety and effectiveness. Until then, health care providers should remain cautious when recommending or endorsing these treatments.

Ultimately, although many patients with heart failure turn to complementary and alternative medicines for additional relief or as an alternative approach, it is important to recognize the limited scientific evidence supporting their efficacy. Pharmacists must engage in open conversations with their patients about CAM use while remaining cautious due to potential interactions with conventional treatments. Further research is needed before these therapies can be fully integrated into standard heart failure management protocols.

Reference

Chow SL, Bozkurt B, Baker WL, et al. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circ. 2022;147(2). doi:10.1161/CIR.0000000000001110