Top Things to Know: Complementary & Alternative Medicines in the Management of Heart Failure (HF)
Published: December 08, 2022
Prepared by Paul St. Laurent, DNP, RN, Sr. Science and Medicine Advisor, Lead
- Complementary and alternative medicines (CAM) are commonly used across the world by diverse populations and ethnicities but remain largely unregulated.
- Although many CAM agents are purported to be efficacious and safe by the public, clinical evidence supporting the use of CAM in heart failure (HF) remains limited and controversial.
- Although some specific CAM agents have been associated with improvement in HF symptoms, functional capacity, and quality of life, others are associated with major adverse cardiac outcomes.
- The goal of this scientific statement is to summarize the published data on efficacy and safety for CAM and adjunctive interventional wellness approaches in HF, and to discuss adverse effects and drug interactions that could influence patient safety
- Health care professionals are strongly encouraged to inquire about CAM use with their patients at every clinical visit including the interactions, benefits, and side-effect profile of CAM and guideline-directed medical therapy using a shared decision-making model.
- Yoga and tai chi are safe and well-tolerated adjunctive therapies for patients with HF. Their beneficial effects on the cardiovascular system are proposed to be attributable to increased parasympathetic and decreased sympathetic activity.
- Many commonly used CAM agents may interact with current medical therapy or worsen outcomes in patients with HF including alcohol, caffeine, gossypol, grapefruit juice, hawthorn, L-arginine, licorice, and lily of the valley. Thus, a collaborative, multidisciplinary team approach including pharmacist involvement is important to monitor and improve drug therapy management and safety.
- Patients may fear criticism from health care professionals and may not disclose their use of CAM therefore it is important that clinicians caring for patients with HF be prepared to openly discuss CAM use without offering critique or judgment so they can obtain a full understanding of the range of treatments being used and potential interactions.
- Multidisciplinary collaboration with practitioners of traditional and nontraditional medical systems are encouraged to improve transparency, safety, and wellness in patients with HF who use CAM as adjunctive treatment to guideline-directed medical therapy.
- There is an urgent need for additional mechanistic studies, and well-designed, sufficiently powered randomized clinical trials to evaluate the safety and efficacy of CAM in patients with HF.
Citation
Chow SL, Bozkurt B, Baker WL, Bleske BE, Breathett K, Fonarow GC, Greenberg B, Khazanie P, Leclerc J, Morris AA, Reza N, Yancy CW; 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 [published ahead of print December 8, 2022]. Circulation. doi: 10.1161/CIR.0000000000001110