American Heart Association Statement Addresses Alternative Treatments for Heart Failure

A recent statement from the American Heart Association suggests that activities such as yoga and tai-chi may be beneficial for patients with heart failure.

The statement, titled Complementary and Alternative Medicines in the Management of Heart Failure, defines alternative and complementary medicine (CAM) therapies as medical practices, supplements, and approaches to healing that are not supported by evidence-based practice guidelines. Alternative medicine products do not require pharmaceutical prescriptions or medical guidance. A such, certain CAMs may pose a serious risk for patients with heart failure.

“They are available to consumers without having to demonstrate efficacy or safety to meet the same standards as prescription medications,” said Sheryl L. Chow, PharmD, FAHA, an associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, California, and associate clinical professor of medicine at the University of California in Irvine, in a recent press release. “[Patients] may not be aware of the possibility of interactions with prescription medicines or other effects on their health.”

Heart failure, defined as an abnormally functioning heart, is estimated to affect more than 6 million adults 20 years of age and older in the United States alone. The statement advises that health care professionals and pharmacists consult with patients with heart failure about the use of alternative therapies before beginning a regimen.

The most beneficial alternative medicine supported by evidence is Omega-3 polyunsaturated fatty acids (PUFA, fish oil). Omega-3 PUFA can help the heart pump blood and reduce risk of heart failure. Tai chi and yoga may benefit patients as well, which lower blood pressure and can improve quality of life.

Conversely, supplementation with alternative therapies may have harmful adverse effects for patients with heart failure. For example, lily of the valley—which contains active, if not milder, chemicals found in the heart failure medication digoxin— is often taken as a natural supplement for mild heart failure.

Despite its intended use, lily of the valley may worsen the condition of patients on digoxin, “causing very low potassium levels, a condition known as hypokalemia…[and] also may cause irregular heartbeat, confusion, and tiredness,” the statement reported.

Other harmful supplements may include vitamin D and blue cohosh. The statement noted that many alternative therapies have mixed reviews. There are not enough data on coenzyme Q10, Co-Q10, that proves it can improve heart failure, despite rumors, according to the AHA. And vitamin E, though to improve conditions for heart failure patients with preserved ejection fraction, is associated with an increased risk of hospitalization in this patient population.

In the United States, more than 30% of people with heart failure use CAMs, according to the statement. These medicines are not regulated by the federal government, Chow explains, and limited data makes it difficult to guide dose decisions, especially without professional consult.

“More 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 in the press release.

Reference

American Heart Association. Some benefits, potential risks with alternative medicines for heart failure. News Release. EurekAlert! December 8, 2022. Accessed on December 9, 2022. https://www.eurekalert.org/news-releases/973417.