Alternative HF therapies could worsen symptoms, interact with prescribed medications
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Complementary and alternative therapies for HF could potentially worsen symptoms and interact with prescribed medications, and clinicians and patients should be aware of a lack of federal regulation for such therapies, researchers wrote.
In a new American Heart Association scientific statement, researchers noted that health care professionals should ask patients about the use of complementary and alternative therapies during clinic visits, provide guidance on their risks and benefits, and identify if it is possible to safely integrate such therapies into the care plan. According to the statement, it is estimated that more than 30% of people with HF in the U.S. use complementary and alternative medicines.
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“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,” Sheryl L. Chow, PharmD, FAHA, associate professor of pharmacy practice at Western University of Health Sciences, associate clinical professor of medicine at the University of California, Irvine, and chair of the scientific statement writing group, said in a press release. “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.“
Agents with possible benefit
The use of several complementary and alternative medicine agents has been examined in observational studies and clinical trials of people with HF. In some reports, the use of specific agents has been associated with improvement in HF symptoms, functional capacity, quality of life, and major adverse CV events, according to the researchers.
“Although complementary and alternative medicine agents should not supplant or replace standard guideline-directed medical therapy, HF clinicians should be familiar with the clinical effects of complementary and alternative medicine agents in patients with HF, because these agents may be used in the treatment of HF and non-HF conditions, and patients may prefer to take these agents independent of health care professional advice,” the researchers wrote.
The researchers highlighted some alternative therapies that may offer benefit to people with HF, including omega-3 polyunsaturated fatty acids, which have the strongest evidence for clinical benefit in people with HF and may be used safely, in moderation, in consultation a health care team.
Additionally, yoga and tai chi, in addition to standard treatment, may help improve exercise tolerance and quality of life and decrease BP, the authors wrote.
Alternative therapies to avoid
The statement noted that some therapies were found to have harmful effects, such as interactions with common HF medications and changes in heart contraction, BP, electrolytes and fluid levels. These include the herbal supplement blue cohosh, which could cause tachycardia, elevated BP, chest pain and may increase blood glucose, and could potentially decrease the effect of medications taken to treat hypertension and type 2 diabetes.
Lily of the valley may be harmful when taken with digoxin by causing hypokalemia, and could be associated with arrhythmia, confusion and fatigue, the researchers wrote.
Other treatments or supplements have been shown to be ineffective for HF symptoms or have mixed findings, including routine thiamine supplementation, vitamin E, coenzyme Q10 and hawthorn, according to the researchers.
“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,” Chow said in the release. “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.”
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