Use of complementary therapies by individuals with or at risk for cardiovascular disease: results of the 2007 National Health Interview Survey

Physician Office Visits That Included Complementary Health Approaches in U.S. Adults: 2005-2015

Introduction: The Institute of Medicine has described the need for comparing models of care delivery involving complementary health approaches and conventional medical practitioners. As a step toward addressing this need, we used a nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided. Methods: NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. We examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for health visit. We ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide development of logistic regression models. Results: Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem. Conclusion: We present an overview of the first study of office-based physician visits where complementary health approaches were recommended or ordered to their patients. These data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.

Systematic Review of Polyherbal Combinations Used in Metabolic Syndrome

Background: Metabolic syndrome (MetS) is a multifactorial disease, whose main stay of prevention and management is life-style modification which is difficult to attain. Combination of herbs have proven more efficacious in multi-targeted diseases, as compared to individual herbs owing to the "effect enhancing and side-effect neutralizing" properties of herbs, which forms the basis of polyherbal therapies This led us to review literature on the efficacy of herbal combinations in MetS. Methods: Electronic search of literature was conducted by using Cinnahl, Pubmed central, Cochrane and Web of Science, whereas, Google scholar was used as secondary search tool. The key words used were "metabolic syndrome, herbal/poly herbal," metabolic syndrome, clinical trial" and the timings were limited between 2005-2020. Results: After filtering and removing duplications by using PRISMA guidelines, search results were limited to 41 studies, out of which 24 studies were evaluated for combinations used in animal models and 15 in clinical trials related to metabolic syndrome. SPICE and SPIDER models were used to assess the clinical trials, whereas, a checklist and a qualitative and a semi-quantitative questionnaire was formulated to report the findings for animal based studies. Taxonomic classification of Poly herbal combinations used in animal and clinical studies was designed. Conclusion: With this study we have identified the potential polyherbal combinations along with a proposed method to validate animal studies through systematic qualitative and quantitative review. This will help researchers to study various herbal combinations in MetS, in the drug development process and will give a future direction to research on prevention and management of MetS through polyherbal combinations.

Effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension: Pretest-posttest study

AIM

To investigate the effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension.

BACKGROUND

Nurse-led interventions are emerging as cost-effective as well as clinically proven in chronic illness management. Hypertension, a leading long-term cardiovascular condition, has autonomic dysregulation and increased sympathetic tone as its pathophysiological background. Complementary interventions evidenced to interplay hypertension pathophysiology.

DESIGN

A pretest-posttest design.

MATERIALS AND METHODS

Uncomplicated primary hypertension outpatients were randomly assigned as study group (n = 173) and control group (n = 173) at a tertiary care hospital. Sociodemographic, clinical, and outcome variables [the baseline blood pressure and galvanic skin response (GSR)] were collected. Study group patients were given four teaching sessions of abdominal breathing-assisted relaxation facilitated by GSR biofeedback. Daily home practice was encouraged and monitored to measure the effects on blood pressure and GSR at the end of the 1st, 2nd, and 3rd month of intervention.

RESULTS

The study group participants showed significant decrease in mean (SD) systolic [140.77 (8.31) to 136.93 (7.96), F = 469.08] and diastolic blood pressure [88.24 (5.42) to 85.77 (4.66), F = 208.21]. In contrast, control group participants had a mild increase in the mean systolic (F = 6.02) and diastolic blood pressure (F = 4.70) values from pretest to posttests. GSR showed a significant increase from 559.63 (226.33) to 615.03 (232.24), (F = 80.21) from pretest to posttest III.

CONCLUSIONS

Use of home-based biofeedback-centered behavioral interventions enabled BP reduction among hypertensive patients. Further studies should use biochemical markers of sympathetic nervous system activity to endorse this home-based chronic illness intervention.

Conventional and Complementary Healthcare Utilization Among US Adults With Cardiovascular Disease or Cardiovascular Risk Factors: A Nationally Representative Survey

Background

Cardiovascular diseases (CVDs) and their risk factors need guideline‐oriented treatment to provide the best benefit for patients. These guidelines include recommendations for regular checkups, realized by general medical practitioners. In addition, individuals with CVD or CVD risk factors tend to use complementary methods for their condition. There is limited information on the association between complementary healthcare utilization and the adherence to recommended conventional health care.

Methods and Results

In this cross‐sectional analysis of the nationally representative 2017 National Health Interview Survey (n=26 742; response rate 80.7%) we examined the prevalence of conventional and complementary healthcare utilization within the past 12 months in individuals with CVD and/or CVD risk factors and the interactions between the two categories of health care. Of all participants, 38.1% reported risk factors for CVD and 11.4% a CVD diagnosis (groups show an overlap). Overall prevalence of visits to conventional and complementary medicine providers and the use of mind–body medicine was high within the population analyzed. Individuals with CVD and/or CVD risk factors using complementary health care were as likely or more likely to consult general practitioners (CVD: adjusted odds ratio [aOR], 1.17; 95% CI, 0.93–1.47; CVD risk: aOR, 1.21; 95% CI, 1.05–1.39) and medical specialists (CVD: aOR, 1.38; 95% CI, 1.17–1.64; CVD risk: aOR, 1.42; 95% CI, 1.28–1.58) than those not using complementary health care. Those using complementary health care were as likely to adhere to medical checkup as those not using complementary health care.

Conclusions

Complementary healthcare utilization use was not associated with a reduced adherence to conventional health care and recommended checkups. The potential positive association of complementary and conventional healthcare utilization needs to be confirmed in further studies.

Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey

BACKGROUND

Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mind-body interventions, energy therapies, and alternative medical systems.

METHODS

Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463).

RESULTS

Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p < 0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2-4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23-27%, p < 0.05) and energy therapies (0.2-0.3%, p < 0.05). Use of biological treatments (0.04%, p < 0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001).

CONCLUSIONS

These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

Integrative Medicine and Cardiovascular Disorders

Integrative medicine (IM) has developed an increasingly significant role in health care worldwide, including cardiovascular diseases (CVD). This review describes the commonly used IM in CVD, with particular attention placed with dietary supplements and mind-body therapies. More rigorous research continues to be needed to determine the mechanisms and efficacy of IM cardiovascular morbidity and mortality. Health care providers will need to develop skills in open communication and nonjudgmental dialogue around IM use in discussing treatment plans with their patients.

Uncertain Associations of Major Bleeding and Concurrent Use of Antiplatelet Agents and Chinese Medications: A Nested Case-Crossover Study

Despite the evidence that some commonly used Chinese medications (CMs) have antiplatelet/anticoagulant effects, many patients still used antiplatelets combined with CMs. We conducted a nested case-crossover study to examine the associations between the concomitant use of antiplatelets and CMs and major bleeding using population-based health database in Taiwan. Among the cohort of 79,463 outpatients prescribed antiplatelets (e.g., aspirin and clopidogrel) continuously, 1,209 patients hospitalized with new occurring bleeding in 2012 and 2013 were included. Those recruited patients served as their own controls to compare different times of exposure to prespecified CMs (e.g., Asian ginseng and dong quai) and antiplatelet agents. The periods of case, control 1, and control 2 were defined as 1–4 weeks, 6–9 weeks, and 13–16 weeks before hospitalization, respectively. Conditional logistic regression analyses found that concurrent use of antiplatelet drugs with any of the prespecified CMs in the case period might not significantly increase the risks of bleeding over that in the control periods (OR = 1.00, 95% CI 0.51 to 1.95 and OR = 1.13, 95% CI 0.65 to 1.97). The study showed no strong relationships between hospitalization for major bleeding events and concurrent use of antiplatelet drugs with the prespecified CMs.

Self-medication among people living with hypertension: a review

BACKGROUND

Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes.

OBJECTIVES

This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors.

METHOD

A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs).

RESULTS

Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported.

CONCLUSION

This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.

Epidemiology of complementary and alternative medicine therapy use in allogeneic hematopoietic stem cell transplant survivorship patients in Australia

In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402-item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind-body therapy (17.2%), herbal supplements (13.5%), manipulative and body-based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population.

Prevalence and characteristics of Australian women who use prayer or spiritual healing: A nationally representative cross-sectional study

OBJECTIVES

To determine the prevalence and characteristics of users of prayer or spiritual healing among Australian women aged 31-36 years.

DESIGN AND SETTING

This cross-sectional study was conducted as a part of the Australian Longitudinal Study on Women's Health (ALSWH). The sample used in the current sub-study were participants from the 'young' cohort (1973-78) (n=8180) aged between 31 and 36 years.

MAIN OUTCOME MEASURE

Use of prayer or spiritual healing

RESULTS

Prayer or spiritual healing was used on a regular basis by 20% of women aged between 31 and 36 years in 2009. Women who had symptoms of chronic illnesses (p=0.001), women who had never smoked (p=0.001) and women who used other forms of CAM (p<0.001) were significantly more likely to use prayer or spiritual healing.

CONCLUSION

A significant proportion of women use prayer or spiritual healing on a regular basis. Further research is required to better understand their rationale for using prayer or spiritual healing and its perceived impact on health related outcomes and general well-being.