A third of patients do not disclose their use of complementary therapy to physicians

Fuschia Sirois

A new study indicates that just over a third of patients with cardiovascular disease use some form of complementary therapy. Furthermore, of these patients, one third do not disclose that they use (or have used) complementary therapy to their physician and the main reason for not disclosing their use of such therapies is because the physician did not ask them.

Fuschia M Sirois (Department of Psychology, University of Sheffield, Sheffield, UK) and others report in the American Journal of Cardiology that complementary health approaches are “an increasingly popular healthcare option among cardiac patients”. However, they add that disclosure of the use of such therapies to physicians is “not uniformly high” and note that non-disclosure poses some “potential risks”. “Non-vitamin, non-mineral and herbal products, one of the most commonly used groups of complementary health approaches among cardiac patients, can interact  with medications or have adverse effects of the cardiovascular haemostatic system. For example, herbal products such as St John’s Wort decrease serum digoxin concentration, whereas Hawthorn increases the effects of digoxin,” Sirois et al comment.

The aim of the present study, therefore, was to assess the prevalence and patterns of complementary health approaches and disclosure among people with cardiovascular disease. The author also looked at the reasons for non-disclosure.

Using data from the 2012 US National Health Interview Survey, they identified that a third of people with cardiovascular disease used complementary health approaches in the year prior to being interviewed. A fifth used non-vitamin and herbal products, followed by chiropractic/osteopathic manipulation, massage, mind-body techniques, and relaxation techniques.

The authors report: “About one-third did not disclose their use of complementary health approaches to their physician. Of those who did not disclose, the most common reason stated was the provider did not ask.” They add that patients who had the highest level of education or were cohabiting/never married (vs. married) were the most likely to not disclose their use of complementary therapy. Sirois told Cardiovascular News that: “Younger and better educated patients may be more likely to use the internet or other sources to research whether complementary health approaches interacts with their cardiac treatments; thus, they may not believe it is necessary to disclose their complementary health approach use to physicians. So if they are not asked, they will not tell.”

According to Sirois et al, this figure of one third is “promising” as it is lower than that the figure reported in a 2002 survey. However, they observe that the rate of non-disclosure remains “concerning” and, given the high use of complementary therapy, highlights the importance of physicians asking their patients about the use of complementary health approaches. They state that the timing of initiating any discussions about complementary health approaches is “an important consideration”. “Evidence indicates that people may begin complementary health approach after experiencing a myocardial infarction. In one study of cardiovascular disease patients from 24 US sites, a third reported initiating the use of complementary health approaches within the year of experiencing myocardial infarction,” authors state.

Given their findings, they advise that “initiating discussion about contemporary health approach use upon uptake, and following up regarding any change in complementary health approach use over time may be the best strategy to minimise potential issues associated with non-disclosure, such as harmful interactions or reduced adherence to cardiovascular disease medication”.


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