Symptom Management

The AHA Releases Statement on the Use of Alternative Treatments for Heart Failure

01/31/2023

In an effort to regulate the treatment of heart failure with complementary and alternative medicines in the United States, the American Heart Association (AHA) released a scientific statement regarding the benefits and risks of using complementary and alternative medicines to manage symptoms.

Although commonly used both in the United States and around the world, there is limited clinical evidence that supports the use of complementary and alternative medicine for the treatment of heart failure. The treatment options typically move away from the standard beliefs of conventional medicine and are considered non-mainstream. According to the statement, the AHA estimates that about 30% of people in the United States with heart failure use complementary and alternative therapies.

The writing group, which consisted of cardiologists, scientists, pharmacists, and a nurse practitioner, used data prior to November 2021 to construct their statement and recommendations for treatment. Based on the evidence that they gathered, the researchers listed treatments that were potentially harmful, potentially beneficial, and had uncertainties of safety.

The researchers label the following as potentially harmful for the treatment of heart failure:

  • Alcohol
  • Aloe vera
  • Caffeine
  • Guar gum
  • Hawthorn (Crataegus spp.)
  • L-arginine
  • Policosanol

The researchers label the following as potentially beneficial for the treatment of heart failure:

  • Co-Q10
  • D-Ribose
  • L-carnitine
  • Omega-3 fatty acids
  • Thiamine (with deficiency)
  • Vitamin C (with deficiency)
  • Vitamin D (with deficiency)
  • Yoga and/or tai-chi with guideline-directed medical therapy

Considering the popularity of complementary and alternative therapies, the AHA writing group suggested several multidisciplinary approaches for physicians to better inform their patients about these medications. For example, the authors emphasized the need for a multidisciplinary conversation between the treatment team and the patient about complementary and alternative therapies.

“Unfortunately, because many complementary and alternative medications are not evidence-based, health care professionals may not know how to integrate this information into traditional clinical practice,” the authors wrote. “Patients may fear criticism from health care professionals and may not disclose their use.”

To avoid coming off as critical or judgmental, the authors suggested that physicians prepare themselves for these conversations and encouraged health care professionals to leverage the knowledge of the (often underutilized) pharmacist on the multidisciplinary team.

“A team-based approach would optimize care by encouraging patient disclosure of complementary and alternative medications during medication reconciliation by nurses and pharmacists, harnessing the expertise of pharmacists with interactions and drug therapy management while offloading cardiologists and advanced practice clinicians managing other areas of diagnosis and medical care,” the authors wrote in their statement.

Even with increased patient awareness, the authors signaled an urgent need to develop more studies to increase the evidence base on these medications.

“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,” the researchers wrote in their statement. “More research and well-powered randomized controlled trials are warranted to further evaluate [complementary and alternative medicine] efficacy and adverse effects in this population,” the researcher continued. “Education, communication, and collaboration between patients, multidisciplinary health care professionals, and nontraditional practitioners are encouraged in patients with [heart failure] to promote transparency and improve outcomes.”

 

Reference:

Chow SL, Bozkurt B, Baker WL, et al. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circulation. Published online December 8, 2023. doi:10.1161/CIR.0000000000001110