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A Cheat Sheet For Heart Failure Treatments

AMA Lays Out Potential Benefits & Risks

Risks and benefits of complementary and alternative medicine therapies for people with heart failure.

By John Salak –

Heart failure is a serious business that confronts over six million Americans 20 and older. The condition doesn’t mean the heart has stopped, but it does mean that it isn’t pumping enough blood and oxygen to support the body’s other organs.

Diabetes, high blood pressure, obesity, heart disease, smoking, excessive alcohol, lack of physical activities and other factors all increase the risk of heart failure, according to the Centers for Disease Control and Prevention (CDC). Treatments include everything from restricting intake of salt and certain liquids to more extreme measures that involve medication, heart transplants and other surgeries.

Patients, however, are increasingly turning to complementary and alternative medicines (CAMs), which reflects a wider trend that by some estimates sees more than half of Americans embracing CAMs for any number of reasons. 

The American Heart Association notes that more than 30 percent of patients use complementary and alternative medicines to support their heart failure treatment. The American Medical Association (AMA), however, warned that CAMs offer both benefits and potentially serious risks.

The AMA laid out its position in a recent statement, which defined complementary and alternative medicine therapy as medical practices, supplements and approaches that do not conform to the standards of conventional, evidence-based practice guidelines. These CAMs 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,” explained statement chair Sheryl L. Chow, an associate professor at Western University of Health Sciences. “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.”

The list of CAMs used for heart failure includes Co-Q10, vitamin D, Ginkgo, grapefruit juice, devil’s claw, alcohol, aloe vera and caffeine. Some patients also practice yoga and tai-chi to treat heart failure, the AMA statement noted.

The AMA statement noted that Omega-3 polyunsaturated fatty acids have the strongest evidence among CAMs for delivering clinical benefits for people with heart failure—if they are used safely, in moderation, in consultation with their health care team. Beyond this, yoga and tai chi were cited in addition to standard treatment to help improve exercise tolerance and quality of life and decrease blood pressure.

Conversely, 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:

Vitamin D supplements, for example, haven’t shown benefits and actually may be harmful when taken with heart failure medications such as digoxin, calcium channel blockers and diuretics.

The AMA also cites that the herbal supplement blue cohosh might increase heart rates and cause high blood pressure, chest pain and may increase blood glucose. The supplement may also decrease the effectiveness of medications taken to treat high blood pressure and Type 2 diabetes.

The root, stems and flower of Lily of the Valley, an alternative treatment for mild heart failure, may be harmful when taken with digoxin by causing low potassium levels as well as irregular heartbeats, confusion and tiredness, the AMA warned.

Some CAM treatments simply lack definitive evidence to determine whether they are harmful or beneficial, which makes relying on these alternatives as potentially dicey. The AMA specifically cited alcohol, vitamin E, Co-Q10 and the flowering scrub Hawthorn as examples of these undetermined CAMs.

The statement stressed the need for healthcare professionals to ask their heart failure patients about their use of CAMs to ensure these individuals aren’t at risk. 

“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.”

 

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