by Glickman-Simon R

  • CHF
  • Heart Failure

Congestive heart failure (CHF) means the heart can’t pump enough blood to meet the needs of the body. It worsens over time. CHF causes breathing problems, swelling in the legs, and lack of strength. There are different possible causes. The most common is a problem with blood flow to the heart.

CHF is treated with habit changes and drugs. Surgery may be needed to help the heart work better and control fluid buildup. Some people may need a new heart from a donor.

Natural Therapies

CHF should not be self-treated. Work closely with your care team. Some natural therapies may be a part of your treatment plan to ease symptoms.

Possibly Effective

Herbs and supplements:

  • Chinese Herbal Medicine —when used with standard care, may lower heart events and improve physical ability. A6-A8
  • Coenzyme Q 10 (CoQ 10 ) plays a role in cell power and is an antioxidant. Some people with CHF have lower levels of CoQ10. Pills may help to ease breathing and increase ability to be active. B8, B9, B11 (Note: CoQ10 may cause problems with blood thinning drugs.)
  • Hawthorn —may help you breathe and be more active. It may also help energy levels when added to standard care.A1-A5
  • Omega-3 fatty acids —Some omega-3s are found in fatty fish. It may lower all-cause death rates.B3, B7


  • Tai Chi —gentle flow exercise. It may help your daily life and ability to be active.C1-C3

May or May Not Be Effective

  • Creatine is found in the body in foods like meat and fish.B5, B6 (Note: Creatine may cause fluid loss. It may also worsen kidney disease and diabetes.)
  • Carnitine —substance the body uses to turn fat into energy. Pills are known as L-carnitine or propionyl-L-carnitine.B1, B2

Unlikely to Be Effective

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or pills you are taking. Some may get in the way of your treatment or health problems, such as:

  • CoQ10 may cause problems with blood thinning drugs.
  • Creatine causes muscles to pull water from the rest of the body. This may cause fluid loss. Drink plenty of water and do not workout in hot weather. Creatine may also worsen kidney disease and diabetes.
  • Omega-3 pills may cause problems with blood thinning drugs.



REFA1 Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patstrength chronic stable New York Heart Association class-III heart failure. Am Heart J. 2002;143:910-915.

REFA2 Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114:665-74.

REFA3 Zick SM, Gillespie B, Aaronson KD. The effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure. Eur J Heart Fail. 2008 May 17.

REFA4 Holubarsch CJ, Colucci WS, et al. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008 Dec;10(12):1255-1263.

REFA5 Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev.2008;CD005312.

REFA6 Li X, Zhang J, et al. A multicenter, randomized, double-blind parallel-group, placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure. J Am Coll Cardiol. 2013 Sep 17;62(12):1065-1072.

REFA7 Zhou Q, Qin WZ, et al. Shengmai (a traditional Chinese herbal medicine) for heart failure. Cochrane Database Syst Rev. 2014 Apr 14;(4):CD005052.

REFA8 Zhu YS, Li YL, Ju JQ, Du F, Zang YP, Wang XB, Sheng J. Oral Chinese Herbal Medicine for Treatment of Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016;2016:1819794.


REFB1 Study on propionyl-L-carnitine in chronic heart failure. Eur Heart J. 1999 Jan;20(1):70-6.

refB2 Rizos I. Three-year survival of patients with heart failure caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J. 2000 Feb;139(2 Pt3):S120-3.

REFB3 Tavazzi L, Maggioni AP, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Oct 4;372(9645):1223-12230.

REFB4 Witham MD, Crighton LJ, Gillespie ND, Struthers AD, McMurdo ME. The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial. Circ Heart Fail. 2010 Mar;3(2):195-201.

REFB5 Cornelissen VA, Defoor JG, et al. Effect of creatine supplementation as a potential adjuvant therapy to exercise training in cardiac patients: a randomized controlled trial. Clin Rehabil. 2010 Nov;24(11):988-999.

REFB6 Horjus DL, Oudman I, van Montfrans GA, Brewster LM. Creatine and creatine analogues in hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2011 Nov 9;11:CD005184.

REFB7 Xin W, Wei W, et al. Effects of fish oil on supplementation on cardiac function in chronic heart failure: a meta-analysis of randomised controlled trials. Heart. 2012 Nov;98(22):1620-1650.

REFB8 Madmani ME, Solaiman AY, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2013;CD008684.

REFB9 Fotino AD, Thompson-Paul AM, et al. Effect of coenzyme Q10 supplementation on heart failure: a meta-analysis. Am J Clin Nutr. 2013 Feb;97(2):268-275.

REFB10 Boxer RS, Kenny AM, Schmotzer BJ, Vest M, Fiutem JJ, Piña IL. A randomized controlled trial of high dose vitamin D3 in patients with heart failure. JACC Heart Fail. 2013 Feb;1(1):84-90.

REFB11 Mortensen SA, Rosenfeldt F, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-649.

Tai Chi

REFC1 Barrow DE, Bedford A, Ives G, O'Toole L, Channer KS. An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study. Postgrad Med J. 2007;83(985):717-721.

REFC2 Yeh GY, Wayne PM, Phillips RS. Tai Chi exercise in patients with chronic heart failure. Med Sport Sci. 2008;52:195-208.

REFC3 Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. 2011 Apr 25;171(8):750-7.

Revision Information

  • Reviewer: EBSCO NAT Review Board Richard Glickman-Simon, MD
  • Review Date: 03/2019
  • Update Date: 03/02/2019