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Health Protocols

Heart Failure

Heart failure arises when the heart can no longer supply enough oxygenated blood to meet the metabolic demands of the body. The American Heart Association expects that more than 8 million Americans will be affected by heart failure by 2030.

Fortunately, the emergence of several novel therapies along with mounting evidence for the efficacy of natural interventions such as coenzyme Q10, hawthorne, and arjuna offer additional hope for patients with heart failure.

Causes and Risk Factors

  • Ischemic heart disease, the primary cause
  • Hypertension
  • Diabetes
  • Obstructive sleep apnea
  • Genetics and family history
  • Smoking
  • Physical inactivity


Diagnosis of heart failure may involve a number of clinical and laboratory tests, including:

  • Physical signs and symptoms
  • Cardiovascular function parameters (eg, left ventricular ejection fraction)
  • Biomarker testing (eg, brain natriuretic peptide)
  • Imaging techniques (eg, echocardiogram, X-rays, CT scans, and MRIs)

Classification and Staging of Heart Failure:

  • NYHA Functional Classification. Classifies patients with cardiac disease into one of four classes based on degree of comfort and levels of physical activity (Class I – IV)
  • American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Staging. Classifies patients at risk for heart disease (stages A and B) and with heart disease (stages C and D).

Conventional Treatment

Treatment considerations for patients at risk for heart failure (ACCF/AHA stage A or B) include:

  • Physical activity
  • Restricting dietary sodium
  • Medications may include:
    • Angiotensin-converting enzyme (ACE) inhibitors
    • Angiotensin receptor blockers (ARBs)
    • Beta blockers

Treatment considerations for patients with heart failure (ACCF/AHA stage C) include:

  • Physical activity
  • CPAP (for patients with sleep apnea)
  • Medical devices
  • Medications - Same as stages A and B with potential addition of the following:
    • Angiotensin receptor-neprilysin inhibitors (ARNIs) (eg, Sacubitril/valsartan)
    • Diuretics
    • ldosterone antagonists
    • Cardiac (digitalis) glycosides
    • Anticoagulants
    • Sinoatrial current inhibitor (eg, Ivabradine)

Treatment considerations for patients with advanced heart failure (ACCF/AHA stage D) may include:

  • Mechanical circulatory support
  • Heart transplant

Novel and Emerging Therapies

  • Trimetazidine
  • Vasopressin receptor antagonists
  • Stem cell therapy
  • Vagus nerve stimulation
  • Testosterone

Targeted Natural Interventions include:

  • Hawthorn. In a randomized controlled study of 2681 patients with a left ventricular ejection fraction ≤35%, 900 mg/day of a standardized hawthorn extract significantly reduced cardiac mortality, and sudden cardiac death was significantly reduced for a subgroup of patients with a left ventricular ejection fraction ≥25%.
  • Arjuna (Terminalia arjuna). In a clinical trial, humans treated with 500 mg daily of arjuna tree bark powder experienced a total cholesterol drop of 9.7%. In a second study, the same dose of arjuna extract given every 8 hours improved endothelial function by 9.3% in smokers.
  • Coenzyme Q10 (CoQ10). Heart failure patients with lower CoQ10 levels have up to a two-fold risk of dying compared to those with higher levels. A groundbreaking 10-year study showed CoQ10 supplementation significantly improved survival for even the most severe heart failure patients while dramatically reducing incidence of hospitalization.
  • Fish oil. In a study of 14 heart failure patients, 8 grams/day of fish oil for 18 weeks led to a 59% reduction in tumor necrosis factor-alpha (an inflammatory protein) in the treatment group versus an increase of 44% in the control group.
  • Carnitine. Several studies evaluating the role of L-carnitine or its analog, propionyl-L-carnitine, in heart failure have shown statistically significant increases in exercise capacity, maximum exercise peak heart rate, and oxygen consumption.