Although a variety of RCTs, a meta-analysis and a systematic review contribute to a broad basis of clinical evidence concerning the use of hawthorn in CHF, it is difficult to translate all this knowledge into practice due to the wide range of daily dosage and treatment duration. However, based on the above-mentioned research evidence and our clinical experience, some conclusions can be drawn. In the case of CHF up to NYHAII a daily dosage of 300 to 900 mg seems to be appropriate. Although most evidence is available on hydroethanolic hawthorn extracts from leaves and flowers, one RCT shows a comparable efficacy for an extract from berries. As hawthorn extracts have been used together with standard medication in the treatment of CHF, in most of the studies its additive efficacy remains the one with quite robust data, although one trial indicates that monotherapy might be possible as well and, one would like to add, at least in the early stages of CHF treatment. The clinical trials seem to show that it might be necessary to treat CHF over a period of 3 to 8 weeks to be able to draw a conclusion on its efficacy. However, the herbal preparations tested so far can be given safely together with standard medication in the treatment of CHF even in the long run - up to 2 years. Yet, even in the herbal preparations from hawthorn which have been examined in RCTs (not to mention the variety of other preparations freely available on the market), the question of phyto-equivalence seems to be an unsolved one (Table 8.1).

When discussing herbal medicine, one should take into account that a treatment decision is largely based on the same procedure as with conventional medicine such as anamnesis and diagnosis. But before talking about treatment options the patient's view on the disease and his or her subjective expectations need to be considered in order to respect them as far as possible in an individual treatment schedule. This includes discussing the pros and cons of a monotherapy with an herbal preparation or a possible combination with conventional drugs in terms of the monotherapy's possible benefits and limitations.

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