People don’t usually tell their doctors that they use supplements or other alternative therapies unless they are asked directly, and they may not know that they could interact with prescription drugs or have other effects on their health. The absence of patient disclosure, in conjunction with the prevalence of uncontrolled, easily available medicines, presents a substantial risk.

The use of complementary and alternative medicines treatments by those suffering from heart failure has both positive and possibly dangerous effects.

Heart failure, a condition that happens when the heart isn’t working correctly, affects an estimated 6 million Americans aged 20 and older.

According to a statement published today in the Association’s flagship, peer-reviewed journal Circulation, analyzing the efficacy and safety of standard therapy, more than 30 percent of heart failure patients in the United States are believed to use complementary and alternative medicines.

You can get complementary and alternative products at pharmacies, health food stores, and online retailers without a prescription or advice from a doctor.

“These products are not federally regulated, and they are available to consumers without having to demonstrate efficacy or safety to meet the same standards as prescription medications,” says Sheryl L. Chow, Pharm.D., FAHA, chair of the scientific statement writing committee and associate clinical professor of medicine at the University of California, Davis. 

People don’t usually tell their healthcare team that they use supplements or other alternative therapies unless they are asked directly, and they may not know that they could interact with prescription drugs or have other effects on their health. The absence of patient disclosure, in conjunction with the prevalence of uncontrolled, easily available medicines, presents a substantial risk.

Patients with heart failure might use supplements like Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil’s claw, alcohol, aloe vera, and caffeine. They might also try practices like yoga and tai chi.

The statement’s authors combed through studies on complementary and alternative medicine (CAM) for heart failure patients published before November 2021.

It is recommended that doctors question patients with heart failure about their use of CAM at each checkup and that doctors discuss the advantages, risks, and interactions between CAM and conventional treatments.

In addition to this, they recommend that pharmacists be included as members of the multidisciplinary health care team in order to provide consultations to patients who have heart failure about the use of complementary and alternative treatments.

Some alternative treatments that have shown promise for patients with heart failure are:

• Omega-3 polyunsaturated fatty acids (PUFA, or fish oil) have the most evidence that they help people with heart failure. They can be used safely, in moderation, and in consultation with their health care team. Omega-3 PUFA is linked to a lower risk of heart failure and a better ability of the heart to pump blood in people who already have heart failure. Atrial fibrillation (an irregular heart rhythm) seems to get worse with higher doses, so doses of 4 grams or more should be avoided.
• In addition to standard care, yoga and Tai Chi may help increase exercise tolerance, improve quality of life, and lower blood pressure.

However, negative side effects were seen with several treatments, including interactions with popular heart failure drugs and changes in cardiac contraction, blood pressure, electrolyte, and fluid levels.

• Even though low levels of vitamin D in the blood are linked to worse heart failure outcomes, taking vitamin D supplements hasn’t been shown to help and may be harmful when taken with digoxin, calcium channel blockers, and diuretics.
• Blue cohosh, a herb derived from the root of a flowering plant native to hardwood woods, has been linked to tachycardia, hypertension, chest discomfort, and a rise in blood sugar levels. It may also make medications for high blood pressure and Type 2 diabetes less effective.
• The active compounds in lily of the valley, which are found in the root, stems, and flower and used in supplements, are comparable to, but less strong than, the heart failure drug digoxin, and have long been used in moderate heart failure. When used with digoxin, it may lead to a disease known as hypokalemia, which is characterized by potassium levels that are dangerously low. In addition, lily of the valley has been linked to an irregular pulse, mental disorientation, and fatigue.

Patients should discuss any potential non-prescribed therapy with their doctor since certain therapies have been demonstrated to be useless based on current research, while others have mixed outcomes.

• Treatment with routine thiamine supplements has not been found to improve heart failure unless the patient has a thiamine shortage.
• Some research on alcohol shows that drinking low to moderate amounts (one to two drinks per day) may help prevent heart failure, while other research shows that drinking too much or too often is bad for the heart muscle and can lead to heart failure.
• There are conflicting results on vitamin E. It may help reduce the risk of heart failure with preserved ejection fraction, a kind of heart failure in which the left ventricle is unable to fill effectively 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 that may be found in tiny levels in organ meats, fatty salmon, and soybean oil, and is widely used as a dietary supplement. Small trials indicate that it may help improve heart failure class, symptoms, and quality of life; nevertheless, it may interfere with blood pressure and anti-clotting medications. For a better understanding of its effects, larger studies are required.
• Some studies have shown that hawthorn, a flowering shrub, can help people with heart failure feel better and be able to exercise more. But it could also make heart failure worse, and research is mixed on whether or not it interacts with digoxin.

“Overall, 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,” adds Chow.

“This scientific statement provides critical information to health care professionals who treat people with heart failure and may be used as a resource for consumers about the potential benefit and harm associated with complementary and alternative medicine products.”

Source: 10.1161/CIR.0000000000001110

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