AHA releases statement on benefits and risks of alternative therapies for heart failure

In a recent scientific statement, the American Heart Association (AHA) outlined research on the safety and efficacy of alternative therapies for heart failure.

The statement, published in the journal, Circulation, was prepared by a group of volunteer writers on behalf of various committees associated with the AHA, such as the Clinical Pharmacology Committee and the Council on Clinical Cardiology. According to the AHA, scientific statements inform the development of practice guidelines, however they do not serve as guidelines alone. For this paper, authors sought to explain the current research surrounding complementary alternative medicine (CAM) therapies for heart failure.  

The list of safe and potentially effective alternative therapies for heart failure included Omega-3 polyunsaturated fatty acids (PUFA, fish oil) supplementation, yoga, and tai chi. According to the statement’s authors, PUFA has the strongest evidence of all CAM interventions for clinical benefit for those with heart failure. It has been associated with a reduced risk of developing heart failure as well as improvements in heart pumping ability for those who already have heart failure. In moderation, the authors said, the supplement has proven to be safe. However, they said doses above four grams should be avoided as high doses have been associated with an increased risk of in atrial fibrillation.

Yoga and tai chi were also listed in the statement as safe therapies for those with heart failure. Research suggests they may decrease blood pressure and result in improved exercise tolerance and quality of life, according to the statement.

Other alternative therapies, the authors explained, may have harmful effects or interactions with common heart failure medications. For example, while low blood levels of vitamin D have been linked to worse heart failure outcomes, vitamin D supplements have not been shown to have significant benefits for patients with heart failure. In addition, according to the AHA, vitamin D can have interactions with heart failure medications such as digoxin, calcium channel blockers, and diuretics.

Another supplement the AHA suggested to avoid giving patients with heart failure was blue cohosh, which could cause a fast heart rate, high blood pressure, chest pain, and may increase blood glucose. In addition, lily of the valley supplements were listed as potentially harmful as they might cause irregular heartbeat, confusion, and tiredness. Lily of the valley, authors warned, should be avoided especially for those taking digoxin because when combined, the therapies can lead to very low potassium levels.

CAM therapies with mixed findings included routine thiamine supplementation, vitamin E supplementation, low-to-moderate alcohol consumption, coenzyme Q10, and hawthorn.

According to the paper’s authors, these results underline the importance of having open conversations about alternative medicine therapies for patients with heart failure and working with their entire healthcare team when suggesting CAM interventions.

“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 chair of the scientific statement writing committee, Sheryl Chow, Pharm.D., FAHA, an associate professor of pharmacy practice and administration at Western University of Health Sciences in Pomona, California, and associate clinical professor of medicine at the University of California in Irvine. “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.”