Symptoms of mild heart failure (NYHA II)

NYHA functional class II heart failure: dyspnoea, fatigue and palpitations on ordinary activity, no symptoms at rest. Diagnosis rests on echocardiography, BNP/NT-proBNP and clinical assessment. The ESC HF 2021 guidelines anchor first-line therapy on ACE inhibitors or ARBs, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors; herbal products are not part of the regimen.

ICD-10 I50.91 drug

Also known as: Mild heart failure, NYHA class II HF, Heart failure with symptoms on moderate exertion

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

CHawthorn (Crataegus monogyna / laevigata)Not recommended · Medicinal plant; EMA HMPC well-established use for mild nervous tension and traditional use in mild chronic heart failure; standardised WS 1442 extract (Crataegutt)Hawthorn is a herbal product with EMA HMPC traditional use for mild chronic heart failure symptoms (NYHA I–II) in patients in whom severe pathology has been excluded. The Cochrane 2008 review reported moderate improvement in exercise tolerance and dyspnoea. The large SPICE trial (Holubarsch 2008, n = 2681, NYHA II–III) gave the headline result: WS 1442 does not reduce cardiovascular mortality on top of standard therapy. The ESC HF 2021 guideline does not include hawthorn in the chronic heart failure treatment algorithm. Hawthorn does not replace ACE inhibitors, beta-blockers, mineralocorticoid antagonists or SGLT2 inhibitors. If hawthorn was offered as a substitute for standard therapy, consider seeking a second opinion from a cardiologist.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit