Complementary and Alternative Medicines in the Management of Heart Failure
What are Complementary and Alternative Medicines?
Complementary and alternative medicines (CAM) are medical practices, products or systems that do not conform to the standard beliefs of conventional medicine. Complementary therapy is a non-mainstream approach used in combination with conventional medicine. An alternative medicine approach replaces conventional therapy altogether.
Mind-body medicine also falls into the CAM domain. According to the National Center for Complementary and Alternative Medicine (NCCAM), mind-body medicine focuses on various practices associated with health promotion, including:
- Relaxation
- Hypnosis
- Visual imagery
- Meditation
- Yoga
- Biofeedback
- Tai chi
- Qi gong
- Reiki
- Cognitive behavioral therapies
- Group support
- Spirituality
How is CAM regulated?
It’s important to know that there is a lack of federal guidance and regulation of CAM products sold in the United States. However, these products are readily accessible to consumers and are becoming more popular. It is estimated that more than 30% of people with heart failure use CAM, and 1 of 5 have used herbal therapy annually.
Misconceptions regarding their benefits have increased the popularity of these products, while the negative effects have been underemphasized and underreported. People who purchase over-the-counter CAM products are often taking prescription medications, which can result in harmful drug interactions.
Before purchasing or taking any over-the-counter CAM products, it is critical to review the websites that provide the actual contents of the supplement from the specific manufacturers.
Safety and Potential for Toxicity
CAM products can cause toxicity, which can occur through direct organ toxicity or drug-drug interactions.
For example, kava is made from Piper methysticum, a plant native to the western Pacific Islands. In the South Pacific, kava is consumed as a beverage socially in ceremonies to promote relaxation, similar to how alcohol is consumed in Western societies. Kava is thought to reduce stress, anxiety and insomnia. It can be taken in tea, capsule, powder or liquid form. However, many have reported liver toxicity, leading to an FDA warning as well as many countries banning or restricting it.
People should always share information with their health care professional about using complementary and alternative medicine. Shared decision-making between patients and health care professionals is necessary to identify ways to safely integrate CAM into a care plan if desired.
Overview of Complementary and Alternative Medicines for Use in Heart Failure Patients
A 2022 scientific statement from the American Heart Association provided information on a variety of CAMs and their use in people with heart failure. The following information may help with shared decision-making regarding the use of CAMs and HF patients. (This information does not represent endorsement from the AHA for any of the products.)
Shared Decision-Making
Shared decision-making is a model of care engaging patients in their medical decisions. It operates under two assumptions:
- Patients have good information and knowledge. Patients should ask questions and express their preferences and opinions regarding their disease and treatment options.
- Health care professionals respect their patients’ preferences. These preferences should be used to guide their recommendations. This results in improved patient satisfaction and even more favorable health outcomes.