Q&A

Hawthorn extract improves chronic heart failure

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  • BACKGROUND: In most herbal reference texts, hawthorn extract (Crataegus monogyna or Crataegus laevigata) is recommended as an oral treatment option for chronic heart failure. In Germany, its use has been approved for use in patients with New York Heart Association (NYHA) class II symptoms, and the extract is marketed as a prescription medicine. The extract is believed to possess positive inotropic and negative chronotropic cardiac properties, and increase coronary blood flow. Unlike most other inotropic agents, it exhibits antiarrhythmic properties.
  • POPULATION STUDIED: Eight clinical trials enrolling 632 patients with chronic heart failure (NYHA classes I–III) were included in the meta-analysis. No standard demographic comparisons were reported with respect to gender, age, race, or socioeconomic status.
  • STUDY DESIGN AND VALIDITY: The authors extensively searched databases, subject experts, and manufacturers for published and unpublished studies. To be included, a trial had to be randomized, double-blinded, and placebo-controlled; use preparations containing only hawthorn extract with leaf and flowers; include patients with chronic heart failure; and report data in a form appropriate for statistical pooling. All articles not in English were translated. Two reviewers independently selected and assessed the methodological quality of the trials. It was not disclosed whether these reviewers were blinded to the source of the studies.
  • OUTCOMES MEASURED: The primary outcome was mean change in maximal workload as compared with baseline. Maximal workload was assessed using bicycle ergometry, with an increase of 25 Watts every 2 minutes until patients had to stop. Secondary outcomes included changes in blood pressure–heart rate product, which was defined as systolic blood pressure in mm Hg x heart rate per minute/100, exercise tolerance, and other heart failure–related symptoms such as dyspnea and fatigue.
  • RESULTS: For the physiological outcome of maximal workload, treatment with hawthorn extract significantly increased maximal workload compared with placebo (weighted mean difference, 7 Watts; 95% confidence interval [CI], 3–11; P<.01; n=310 patients from 4 studies).


 

PRACTICE RECOMMENDATIONS

Based on the findings of this meta-analysis, hawthorn extract can be recommended as an adjunctive therapy to improve the physical performance and ameliorate heart failure–related symptoms of patients with chronic heart failure. It should not replace standard therapy.

The most effective dose is unknown, but these studies used 160–1800 mg/d. Longterm data on hawthorn extract’s impact upon prognosis is still lacking.

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