Alternative heart failure treatments have pros and cons: AHA scientific statement

A new scientific statement from the American Heart Association presents studies on complementary and alternative therapy for heart failure.

When individuals with heart failure utilize complementary and alternative therapies to manage their symptoms, there are a few advantages and the potential for significant hazards.

• Individuals with heart failure should inform their health care team, including pharmacists, if they are taking any over-the-counter or other therapies, such as herbal supplements or fitness regimens, that are not recommended by a physician.

• During clinic appointments, health care providers should inquire about alternative treatments, give advise on their risks and advantages, and determine if they may be safely included into the care plan.

• People with heart failure benefit from yoga and tai chi, and omega-3 polyunsaturated fatty acids may be beneficial for some. Other regularly used over-the-counter medications or supplements, such as vitamin D, blue cohosh, and lily of the valley, have safety issues.

According to a new American Heart Association scientific statement published today in the Association's flagship, peer-reviewed journal Circulation, there are some benefits and potentially serious risks when people with heart failure use complementary and alternative medicines (CAM) to manage symptoms, so involving the health care team is important for safety.

The "Complementary and Alternative Medicines in the Management of Heart Failure" statement evaluates the efficacy and safety of CAM therapies used for the treatment of heart failure. It is believed that more than 30 percent of heart failure patients in the United States utilize complementary and alternative therapies.

The declaration describes complementary and alternative medicine treatment as medical methods, substances, and techniques that do not adhere to the evidence-based, conventional practice recommendations. Complementary and alternative items are accessible at pharmacies, health food shops, and internet vendors without prescriptions or medical supervision.

These items are offered to consumers without needing to show their effectiveness or safety in accordance with the same requirements as prescription drugs. People seldom inform their health care team about their use of supplements or other alternative treatments unless expressly requested to do so, and they may be unaware of the potential for drug interactions or other adverse consequences on their health. The combination of uncontrolled, freely available medicines and the absence of patient disclosure presents a high risk of injury.

Patients with heart failure may take supplements like Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil's claw, alcohol, aloe vera, and caffeine, as well as techniques like yoga and tai chi, as examples of complementary and alternative therapy. The statement drafting committee evaluated studies published before to November 2021 on CAM and heart failure patients.

The organization that drafted the statement recommends health care practitioners to question their patients with heart failure about their use of complementary and alternative treatments at every health care visit and to discuss possible drug interactions, benefits, and potential adverse effects of CAM. In addition, they recommend that pharmacists be involved in the multidisciplinary health care team to give advice on the use of complementary and alternative medicines for heart failure patients.

Alternative medicines that may assist individuals with heart failure include: • Srongest evidence among complementary and alternative agents for therapeutic benefit in individuals with heart failure and may be used safely, in moderation, and in cooperation with their health care team. Omega-3 PUFA is connected with a decreased chance of developing heart failure and, for individuals who already have heart failure, with improvements in the pumping function of the heart. There seems to be a dose-related increase in atrial fibrillation (irregular heart rhythm), thus dosages of 4 grams or more should be avoided. • Yoga and Tai Chi may help improve exercise tolerance, quality of life, and blood pressure in addition to normal therapy.

In the meanwhile, it was discovered that several treatments had significant side effects, such as interactions with standard drugs for heart failure and changes in cardiac contraction, blood pressure, electrolytes, and fluid levels:

•While low levels of vitamin D in the blood are related with poorer outcomes in heart failure, supplementation has not been demonstrated to be beneficial and may be hazardous when taken with heart failure drugs such as digoxin, calcium channel blockers, and diuretics.

• Blue cohosh, a herb derived from the root of a flowering plant found in hardwood woods, may induce tachycardia, high blood pressure, chest discomfort, and a spike in blood glucose. It may also reduce the effectiveness of drugs used to treat high blood pressure and Type 2 diabetes. • Lily of the valley has been used for a long time to treat moderate heart failure because it contains active compounds comparable to, but less powerful than, the heart failure medication digoxin. It may be hazardous when used with digoxin because it causes hypokalemia, or very low potassium levels. Additionally, lily of the valley may produce an erratic pulse, disorientation, and fatigue.

Other therapies have been demonstrated to be unsuccessful based on existing research or have mixed results, emphasizing the need for patients to discuss any non-prescribed therapy with a health care professional:

• Routine thiamine supplementation has not been found to be useful for treating heart failure unless this particular vitamin shortage is present.

• Research on alcohol is inconsistent, with some evidence indicating that consuming low-to-moderate quantities (1 to 2 drinks per day) is connected with avoiding heart failure, however chronic drinking or ingestion of greater amounts is known to be toxic to the heart muscle and lead to heart failure.

There are conflicting results on vitamin E. It may reduce the risk of heart failure with intact ejection fraction, a condition in which the left ventricle cannot adequately fill with blood between heartbeats. However, it has also been linked to a higher risk of hospitalization among those with heart failure.

• Co-Q10, also known as coenzyme Q10, is an antioxidant present in tiny quantities in organ meats, oily salmon, and soybean oil, and is widely used as a dietary supplement. However, it may interfere with blood pressure-lowering and anticoagulant drugs. More extensive studies are required to properly comprehend its impacts.

• Hawthorn, a flowering plant, has been proven in certain trials to relieve heart failure symptoms such as tiredness and boost exercise tolerance. However, it has the potential to exacerbate heart failure, and there are contradictory studies about whether it interacts with digoxin.

Overall, further high-quality research and adequately powered randomized controlled trials are required to better comprehend the risks and advantages of complementary and alternative medicine therapy for individuals with heart failure. This scientific statement offers vital information to health care professionals who treat patients with heart failure and may serve as a resource for consumers seeking information on the possible benefits and risks of complementary and alternative medicine products.

This scientific statement was prepared on behalf of the American Heart Association's Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; the Council on Epidemiology and Prevention; and the Council on Cardiovascular and Stroke Nursing by the volunteer writing group. The American Heart Association's scientific statements raise awareness of cardiovascular illnesses and stroke-related topics and aid in making educated health care choices. Scientific statements describe what is presently known about a subject and which areas need more study. While scientific statements contribute to the establishment of guidelines, they do not provide specific therapeutic recommendations. American Heart Association guidelines are the official clinical practice recommendations of the Association.

Reference-

Chow, Sheryl L., et al. "Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement from the American Heart Association." Circulation, 2022, https://doi.org10.1161/CIR.0000000000001110.