Integrating supplementation in the management of patients with heart failure: an evidence-based review

ABSTRACT

Introduction

Complementary, alternative and integrative medicine includes a myriad of therapies including herbal medicines, vitamins, dietary interventions and more, that are taken alone or in adjunct to standard conventional treatment. Often the main goals are to slow progression of disease, increase effectiveness of a drug, reduce side effects and improve quality of life. The study of these therapies and their influence in heart failure is not new. However, even for an experienced clinician, a gap exists between the literature and the application of knowledge to make a confident recommendation.

Areas Covered

This review has a focus on specific supplements that are commonly used for individuals with HF. It discusses the mechanism of action, expected benefits, potential adverse effects, suggested doses, forms and drug interactions of these therapies. The literature search methodology included using medical subject headings terms to search in PubMed. Articles used were screened and critically appraised by the authors of this review.

Expert Opinion

There are promising outcomes pertaining to the use of CAM in patients with HF. Advances in large scale, randomized, placebo-controlled trials are necessary to support evidence-based decision making regarding the use of supplements in conjunction, and in comparison, to conventional therapies for heart failure.

KEYWORDS:

• Carnitine
• coenzyme Q10
• hawthorn
• heart failure
• integrative medicine
• magnesium
• supplementation
• vitamin D

Article highlights

79% of Canadians have used one or more complementary or alternative medicines in their lifetime, emphasizing the importance of physician education and understanding of these therapies

Supplements show promising efficacy in patients with heart failure, while being well tolerated and safely combined with medications

Many Complementary and Alternative Medicine (CAM) products have specific formulation requirements, which when not acknowledged, could result in poor study outcomes

CAM studies face limitations including small sample sizes, short duration of study and/or risk of bias. Further large-scale trials are needed to truly evaluate their impact

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter and materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.