Evidence supporting the use of: Thiamin (vitamin B1)
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Thiamin (vitamin B1) has some scientific rationale for use in supporting patients with Congestive Heart Failure (CHF), though the evidence is limited and not robust. Thiamin is a critical coenzyme in carbohydrate metabolism and energy production, particularly in heart and muscle tissue. Diuretics, especially loop diuretics like furosemide, are commonly prescribed for CHF and can increase urinary excretion of thiamin, leading to deficiency. Several small studies and case reports have documented low thiamin levels in CHF patients, especially those on long-term diuretic therapy. Some randomized controlled trials have shown that thiamin supplementation may improve left ventricular ejection fraction and symptoms in CHF patients, though the effect sizes are moderate and findings are not always consistent.

A 2013 meta-analysis (Smithline et al.) found some improvement in cardiac function with thiamin supplementation, but the studies reviewed were small and of variable quality. Current heart failure guidelines do not universally recommend thiamin supplementation except in cases of proven deficiency or suspicion thereof. However, due to the low risk and cost of supplementation, and the plausible mechanism involving diuretic-induced deficiency, some clinicians consider empiric supplementation reasonable in select patients.

In summary, there is a modest body of scientific evidence supporting the use of thiamin in CHF, particularly in patients at risk for deficiency, but more high-quality, large-scale trials are needed to firmly establish its clinical benefit.

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