The use of alternative therapies such as vitamins and minerals by pediatric cardiology patients in Canada is high. Such use can result in interactions with prescribed drugs, but one-third of respondents did not discuss this use with their physician, reports a study in CMAJ Open.
Many studies of adult cardiac patients have documented use of complementary and alternative medicine products, but little is known about use of these therapies in pediatric cardiology.
A study of 176 pediatric cardiology patients with a mean age of 7.3 years at the Stollery Children's Hospital in Edmonton, Alberta, and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Ontario, found that use of complementary and alternative medicine was common in patients, although it differed by hospital. At the Stollery Children's Hospital, 64% of cardiology patients used complementary and alternative medicine products and practices compared with 36% at CHEO. Two-thirds of patients at CHEO (68%) had insurance for these therapies compared with 39% at Stollery.
Some highlights from the study:
Multivitamins were the most commonly used complementary and alternative medicine products (71%), followed by vitamin C (22%), calcium (13%), cold remedies (12%), fish oil/omega-3 fatty acids (12% each) and probiotics (9%).
The most common practices include massage (38%), faith healing (25%), chiropractic treatments (20%), aromatherapy (15%) and Aboriginal healing (8%).
Almost half (44%) of patients used complementary and alternative medicine products along with conventional treatments, a usage much higher than that reported in previous studies (3% to 20%).
One-third of the respondents did not discuss combined use of complementary and alternative medicine products and conventional treatments with their physicians. Natural health products such as vitamins and minerals can interact with prescription drugs and cause adverse events.
"Despite their frequent concurrent use, caution is recommended [when using natural health products] because of the potential for interactions," writes Dr. Sunita Vohra, CARE Program, Department of Pediatrics, University of Alberta, Edmonton, with coauthors. "For example, concurrent use of vitamin C and β-blockers may lead to decreased absorption of the latter. Thiazide diuretics are known to raise blood calcium level, especially if used concurrently with vitamin D, and care should, therefore, also be taken when using them together with calcium supplements."
The researchers urge patients to discuss their use of complementary and alternative medicine products with their physicians.
"Our concern is not that patients use complementary and alternative medicines to improve their health, but that they do so without disclosure. Patient safety rests on disclosure and discussion of all health practices so that adverse events can be avoided."
The authors conclude that "respondents indicated a desire to receive more information regarding complementary and alternative medicine from the cardiology clinic. Physicians should discuss the use of complementary and alternative medicine with these patients and their caregivers, not only to promote patient safety, but also to help support the physician-patient relationship."
The study was conducted by researchers from the University of Alberta, Edmonton, Alberta, Canada; Kanta-Häme Central Hospital, Hämeenlinna, Finland; Palladian Health, West Seneca, New York, United States; and University of Ottawa and the Children's Hospital of Eastern Ottawa, Ottawa, Ontario, Canada.
Read the full research paper: Complementary and alternative medicine: a survey of its use in pediatric cardiology http://www.cmajopen.ca/content/2/4/E217.full.