A scientific statement from the American Heart Association (AHA) published in Circulation recommends that health care providers should ask patients with heart failure (HF) whether they are using any over-the-counter drugs or supplements to treat their HF and whether they engage in specific exercise programs, as commonly used remedies and/or practices may have negative effects on disease outcomes.
The AHA estimated that over 30% of patients with HF in the United States, and up to 76% internationally, use complementary or alternative medicines (CAMs), defined as products that are not federally regulated and do not align with evidence-based guidelines. These therapies can be divided into biological products (herbal or animal-derived products, such as vitamins, pre- or probiotics, and specialty diets) and mind-body medicines (relaxation, meditation, yoga, tai chi, and spirituality).
There has been evidence that some of these medicines or exercises have benefits in the setting of HF. For example, omega-3 polyunsaturated fatty acid supplements have been associated with improved heart pumping among patients with HF and both yoga and tai-chi have been associated with improved quality of life and exercise tolerance.
However, there has also been evidence of harm associated with some CAM approaches. For example, lily of the valley, which has been long used in HF, may increase risk for irregular heart rhythm, confusion, and fatigue as well as decrease potassium levels.
Some CAMs can interact with HF medications. For example, grapefruit juice may increase the bioavailability of drugs, particularly amiodarone, carvedilol, and losartan and digoxin likely has pharmacodynamic interactions with hawthorn, lily of the valley, yellow oleander, common oleander, and ouabain.
Therapies that have been shown to be ineffectual in HF include thiamine, alcohol, coezyme-Q10, hawthorn, and vitamin E. Although likely not harmful, patients should be aware of the lack of efficacy.
Additional study is needed to evaluate the mechanism of CAMs in HF as well as studies which focus on understanding what patient priorities are with regard to CAMs.
The AHA recommended for clinicians to ask their patients whether they are using any supplements or treatments that have not be prescribed. The recommendation authors concluded, “The increasing trend in utilization of complementary and alternative therapies in the United States spans across diverse populations and ethnicities. These agents are frequently purchased without consultation from a health care professional and are rarely reported during office visits by patients. Limited published reports suggest that select alternative therapies might have some clinical benefit, whereas others could worsen HF or interact with medications commonly used by adults with HF. More research and well-powered randomized controlled trials are warranted to further evaluate CAM efficacy and adverse effects in this population.”
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Chow SL, Bozkurt B, Baker WL, et al.; on behalf of the American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circulation. Published online December 8, 2022. doi:10.1161/CIR.0000000000001110