Congestive heart failure and omega-3-fatty acids

Congestive Heart Failure Microchapters
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
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Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kalsang Dolma, M.B.B.S.[2]

Omega-3 Fatty Acid

Therapeutic Role of Omega-3 Fatty Acid in Congestive Heart Failure

Landmark Studies

The GISSI-HF Trial (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico)

• A double blind, placebo controlled trial by GISSI-HF investigator randomly assigned 6975 patients with chronic heart failure of New York Heart Association (NYHA) class II-IV to n-3 PUFA 1 g daily(n=3494) or placebo(n=3481) and were followed up for a median of 3.9 years. The study showed reduced death from any cause in n-3 PUFA group (27%) as compared to placebo group (29%). Also, the end points of deaths and admission to hospitals for cardiovascular reasons is lower in n-3 PUFA group (57%) in comparison to placebo group (59%).
• A substudy of GISSI-HF trial done in 608 chronic heart failure patients indicates an increase in LV ejection fraction in n-3 PUFA group by 8.1% at 1st year, 11.1% at 2 years and 11.5% at 3 years as compare to placebo group with increase of 6.3% at 1 year, 8.2% at 2 years and 9.9% at 3 years. This small but statistically significant advantage in terms of LV function by n-3 PUFA supplementation has been seen in patients with symptomatic heart failure of any etiology.

Preventive Role of Omega-3 Fatty Acid in Congestive Heart Failure

Limited data suggests the preventive role of n-3 PUFA supplementation in lowering the incidence of heart failure. Controlled studies with omega-3 fish oil suggest its cordioprotective role in heart failure. The American Heart Association has recently recommended the use of fish and/or fish oil supplements for all patients with cardiovascular diseases.

Landmark Studies

• A prospective cohort study in 4738 adults of >65 years without heart failure at baseline, has shown that consumption of tuna and other broiled or baked fish is associated with lower incidence of heart failure and no such association is found in individuals consuming fried fish.
• Another prospective cohort study in 2735 US adults without prevalent heart disease has shown that plasma phospholipid eicosapentanoic acid (EPA) concentration is inversely related with incident CHF. This result also supports that participants with higher levels of omega-3 fatty acid are less likely to develop congestive heart failure in follow up.