A new scientific statement from the American Heart Association summarized the efficacy and safety of complementary and alternative medicine (CAM) therapies in the setting of heart failure (HF).
The statement was aimed at patients, the public, all health care professionals directly or indirectly managing patients with HF, and those who use alternative therapeutic approaches and nontraditional medicine in practice. The writing group, composed of cardiologists, scientists, pharmacists, and a nurse practitioner with expertise on CAM in the setting of acute and chronic HF, reviewed the evidence of efficacy and safety of these kinds of therapy, including interactions with HF treatment and adverse effects on HF progression. The group looked at data from primary literature, review articles, consensus documents, and abstracts of landmark studies published before November 2021. The scientific statement was published Dec. 8 by Circulation.
The statement strongly encouraged health care professionals to ask their patients about CAM use at every clinical visit; currently, they rarely ask patients about CAM or document its use in the medical record, it noted. Clinicians should also consider discussing the interactions, benefits, and adverse effect profiles of CAM and guideline-directed medical therapy with patients using a shared decision-making model, according to the statement. Both clinicians and patients should be aware of the current lack of federal oversight and regulation of CAM therapies, since the manufacturing process is not overseen by the FDA, the statement said.
Among CAM agents, omega-3 polyunsaturated fatty acids have the strongest evidence for clinical benefit in patients with HF and are safe when used in moderation, the statement said. Other potentially beneficial CAM therapies were coenzyme Q10, D-ribose, and L-carnitine. Patients can use yoga and tai chi as adjunctive wellness approaches to guideline-directed medical therapy to improve exercise tolerance and quality of life, the statement added. On the other hand, potentially harmful CAM therapies identified in the statement included ginkgo biloba (may increase bleeding risk in patients on anticoagulation), devil's claw (may increase blood pressure), and grapefruit juice (can cause worsening arrhythmias in patients with cardiomyopathy at doses >1,000 mL). In patients with HF who use CAM therapies, a multidisciplinary team with pharmacist involvement can improve drug therapy management and safety, according to the statement.
“More research and well-powered randomized controlled trials are warranted to further evaluate CAM efficacy and adverse effects in this population,” the authors concluded. “Education, communication, and collaboration between patients, multidisciplinary health care professionals, and nontraditional practitioners are encouraged in patients with HF to promote transparency and improve outcomes.”