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Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials
Max H Pittler1, Katja Schmidt, Edzard Ernst
1Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, United Kingdom. M.H.Pittler@exeter.ac.uk
Insights
Hawthorn extract significantly improves exercise capacity and reduces symptoms in chronic heart failure patients. This meta-analysis confirms hawthorn
Area of Science:
- Cardiology
- Pharmacology
- Evidence-Based Medicine
Background:
- Chronic heart failure (CHF) is a complex condition requiring effective treatment strategies.
- Hawthorn extract (Crataegus species) has a long history of use in traditional medicine for cardiovascular conditions.
- Assessing the efficacy of herbal remedies like hawthorn in rigorous clinical trials is crucial for evidence-based practice.
Purpose of the Study:
- To systematically evaluate the clinical evidence for hawthorn extract in treating chronic heart failure.
- To perform a meta-analysis of randomized, double-blind, placebo-controlled trials (RCTs) using hawthorn monopreparations.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.).
- Inclusion of published and unpublished studies, with no language restrictions.
- Independent screening, selection, data extraction, and quality assessment by two reviewers.
- Meta-analysis of data from eligible RCTs involving patients with New York Heart Association (NYHA) classes I-III CHF.
Main Results:
- Eight trials with 632 patients met inclusion criteria for meta-analysis.
- Hawthorn extract significantly improved maximal workload (weighted mean difference [WMD]: 7 Watt; P < 0.01).
- A significant reduction in pressure-heart rate product (WMD: -20; P < 0.01) and improvements in dyspnea and fatigue were observed.
- Adverse events were infrequent, mild, and transient (e.g., nausea, dizziness).
Conclusions:
- Hawthorn extract demonstrates significant benefits as an adjunctive treatment for chronic heart failure.
- The findings support the use of hawthorn extract to improve physiological outcomes and symptoms in CHF patients.
- Further research may explore optimal dosing and long-term effects.
Abstract:
The aim of this meta-analysis was to assess the evidence from rigorous clinical trials of the use of hawthorn extract to treat patients with chronic heart failure. We searched the literature using MEDLINE, EMBASE, the Cochrane Library, CINAHL, CISCOM, and AMED. Experts on and manufacturers of commercial preparations containing hawthorn extract were asked to contribute published and unpublished studies. There were no restrictions about the language of publication. Two reviewers independently performed the screening of studies, selection, validation, data extraction, and the assessment of methodological quality. To be included, studies were required to state that they were randomized, double-blind, and placebo controlled, and used hawthorn extract monopreparations. Thirteen trials met all inclusion criteria. In most of the studies, hawthorn was used as an adjunct to conventional treatment. Eight trials including 632 patients with chronic heart failure (New York Heart Association classes I to III) provided data that were suitable for meta-analysis. For the physiologic outcome of maximal workload, treatment with hawthorn extract was more beneficial than placebo (weighted mean difference, 7 Watt; 95% confidence interval [CI]: 3 to 11 Watt; P < 0.01; n = 310 patients). The pressure-heart rate product also showed a beneficial decrease (weighted mean difference, -20; 95% CI: -32 to -8; n = 264 patients) with hawthorn treatment. Symptoms such as dyspnea and fatigue improved significantly with hawthorn treatment as compared with placebo. Reported adverse events were infrequent, mild, and transient; they included nausea, dizziness, and cardiac and gastrointestinal complaints. In conclusion, these results suggest that there is a significant benefit from hawthorn extract as an adjunctive treatment for chronic heart failure.