Drs MartyTamMD and Christopher Giuliano discuss safety concerns and the appropriatness of adding complementary therapies to guideline-directed treatments. CardioTwitter
from the American Heart Association provides a much-needed evidence-based review of the role of CAM for patients with HF — including potential areas of harm. Although CAM is commonly used worldwide to treat a plethora of medical conditions, most therapies have not been rigorously studied in clinical trials and generally remain unregulated.
Even though the US Food and Drug Administration does not oversee the manufacture of CAM products, any adverse events from these therapies should be reported to the FDA's. Some clinicians may not be aware that this program also applies to alternative medicine products. Furthermore, evaluating the causality of adverse reactions can be challenging because patients with HF typically have complex medical conditions requiring several medications.
Some clinicians may not ask their patients about CAM. To better identify adverse effects associated with alternative therapies, in its statement, the AHA recommends that clinicians make it standard practice to ask patients about their use of any CAM and other wellness therapies. Shared decision-making is especially important to establishing trust between patients and clinicians. This trust cannot develop if a clinician dismisses or ignores a patient's preferences or interest in alternative treatments. As the AHA statement emphasizes, although CAM should never replace standard guideline-directed and evidenced-based HF therapies, clinicians should discuss with interested patients when CAM therapy can be safely considered in conjunction with conventional treatment.
The AHA statement highlights several important considerations when discussing CAM therapy with patients. Along with safety concerns, clinicians should address cost considerations since CAM, as an adjunctive therapy, will increase overall treatment cost. Patients should be informed that the cost of CAM products should not become a barrier to initiating and titrating HF guideline-directed therapies.
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