Condition
    Moderate Evidence
    Effectiveness 3/5

    Hawthorn for Heart Failure

    A Cochrane review found hawthorn extract improved maximal workload and symptoms in chronic heart failure when added to standard treatment. The large SPICE trial then found no reduction in cardiac mortality.

    Overview

    A Cochrane review found hawthorn extract improved maximal workload and symptoms in chronic heart failure when added to standard treatment. The large SPICE trial then found no reduction in cardiac mortality.

    Verdict

    Mixed evidence

    Improves symptoms and exercise capacity as an add-on, but does not improve survival. Strictly adjunctive to guideline-directed therapy.

    How It Works

    Oligomeric procyanidins inhibit phosphodiesterase-3, raising cyclic AMP in cardiac myocytes for a mild positive inotropic effect, while extending the effective refractory period and reducing afterload through nitric oxide-mediated vasodilation.

    Dosing & Protocol

    Typical dose

    Recommended dose
    600-1,800 mg/day standardised extract, in divided doses
    Expected timeframe
    6-12 weeks for symptom and exercise capacity change

    Protocol

    timing
    With meals
    starting dose
    300 mg twice daily of standardised extract
    typical range
    600-1,800 mg/day in two or three doses
    assessment point
    12 weeks, ideally with a six-minute walk test

    Evidence

    What the studies say

    The Cochrane systematic review of randomised trials in chronic heart failure reported significant benefit for maximal workload, exercise tolerance and symptoms including dyspnoea and fatigue, with adverse events comparable to placebo. The SPICE trial, enrolling 2,681 patients with reduced ejection fraction on background therapy, found no significant effect on the primary composite cardiac mortality endpoint, though a prespecified subgroup with less severe left ventricular impairment showed a signal for delayed cardiac death. Taken together the evidence supports symptomatic and functional benefit without disease modification, which is a coherent and honest position rather than a contradiction.

    Hawthorn extract for treating chronic heart failure (Cochrane review)

    Score: 9/10
    2008
    systematic_review
    n=855

    Pittler MH, Guo R, Ernst E

    Maximal workload increased significantly with hawthorn (weighted mean difference 5.35 watts).

    View source

    Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials

    Score: 8/10
    2003
    meta_analysis
    n=632

    Pittler MH, Schmidt K, Ernst E

    Maximal workload, pressure-heart rate product and symptom scores improved significantly with hawthorn.

    View source

    The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial

    Score: 9/10
    2008
    rct
    n=2681

    Holubarsch CJ, Colucci WS, Meinertz T +2 more

    The primary composite endpoint of cardiac mortality and hospitalisation was not significantly reduced.

    View source

    Safety

    Caveats

    No mortality benefit was demonstrated in the largest trial. Hawthorn must sit alongside, never in place of, ACE inhibitors, beta blockers, MRAs and SGLT2 inhibitors.

    Less likely to help if

    People with severe or decompensated heart failure, and anyone hoping for prognostic benefit rather than symptom relief.

    Medical Disclaimer

    The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.