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, according to a new American Heart Association scientific statement published today in the Association's flagship, peer-reviewed journalCirculation.
An estimated 6 million people ages 20 and older in the U.S. have heart failure, a condition that occurs when the heart isn't functioning normally. The statement, "Complementary and Alternative Medicines in the Management of Heart Failure," assesses the effectiveness and safety of CAM therapies used for heart failure treatment. According to the statement, it's estimated that more than 30% of people with heart failure in the U.S. use complementary and alternative medicines.
The statement defines complementary and alternative medicine therapy as medical practices, supplements and approaches that do not conform to the standards of conventional, evidence-based practice guidelines. Complementary and alternative products are available without prescriptions or medical guidance at pharmacies, health food stores and online retailers.
"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," said Chair of the scientific statement writing committee Sheryl L. Chow, Pharm.D., FAHA, an associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, Calif., and associate clinical professor of medicine at the University of California in Irvine. "People rarely tell their health care team about their use of supplements or other alternative therapies unless specifically asked, and they may not be aware of the possibility of interactions with prescription medicines or other effects on their health. The combination of unregulated, readily accessible therapies and the lack of patient disclosure creates significant potential for harm."
Examples of complementary and alternative therapies that heart failure patients might use include supplements such as Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil's claw, alcohol, aloe vera and caffeine, or practices such as yoga and tai-chi. The statement writing group reviewed research published before Nov. 2021 on CAM among people with heart failure.
The statement writing group advises health care professionals to ask their patients with heart failure at every health care visit about their use of complementary and alternative therapies and talk about potential medication interactions, benefits and potential side effects of CAM. In addition, they suggest that pharmacists are included in the multidisciplinary health care team to provide consultations about the use of complementary and alternative therapies for people with heart failure.
Alternative therapies that may benefit people with heart failure include:
Meanwhile, some therapies were found to have harmful effects, such as interactions with common heart failure medications and changes in heart contraction, blood pressure, electrolytes and fluid levels:
Other therapies have been shown as ineffective based on current data, or have mixed findings, highlighting the importance of patients having a discussion with a health care professional about any non-prescribed treatments:
"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," said 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."
This scientific statement was prepared by the volunteer writing group 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. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association's official clinical practice recommendations.
Co-authors are Vice Chair Biykem Bozkurt, M.D., Ph.D., FAHA; William L. Baker, Pharm.D., FAHA; Barry E. Bleske, Pharm.D.; Khadijah Breathett, M.D., M.S., FAHA; Gregg C. Fonarow, M.D., FAHA; Barry Greenberg, M.D., FAHA; Prateeti Khazanie, M.D., M.P.H.; Jacinthe Leclerc, R.N., Ph.D., FAHA; Alanna A. Morris, M.D., M.Sc.; Nosheen Reza, M.D.; and Clyde W. Yancy, M.D., FAHA. Authors' disclosures are listed in the manuscript.
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