Condition

Heart Failure

Heart failure means the heart cannot pump blood well enough for the body's needs, and the energy-starved muscle struggles to contract, leaving people tired, breathless and prone to fluid buildup. Coenzyme Q10 and omega-3 fatty acids have the strongest support among supplements, and small trials of coenzyme Q10 found blood flow went up. Those trials included only 23 people in total, so the evidence for that finding is limited.

Sources: PMID 16882678; PMID 17644511

Supplements studied: 14
Medicines and peptides: 2
Graded outcomes: 17
Trials: 21
People studied: 163,152

Evidence by supplement

Strong
Moderate
Limited
Very limited

14 supplements

Citrulline

Citrulline: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Blood Pressure Small Improvement	Improves (the measure goes down)	Small effect	7 studies	65 people
Studies that measured blood pressure Effect of oral L-citrulline on brachial and aortic blood pressure defined by resting status: evidence from randomized controlled trialsNutr Metab · PMID 31889969 Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementationCardiol J · PMID 23224924 Effect of L-arginine or L-citrulline oral supplementation on blood pressure and right ventricular function in heart failure patients with preserved ejection fractionCardiol J · PMID 21154265 and 4 more on the Citrulline page
	Exercise Tolerance	Improves (the measure goes up)			30 people
	Left Ventricular Ejection Fraction	Improves (the measure goes up)			35 people
	Right Ventricular Ejection Fraction	Improves (the measure goes up)			65 people

Resveratrol

Resveratrol: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Blood Urea Nitrogen (BUN) Small Decrease	Improves (the measure goes down)	Small effect		894 people
	Kidney Function	Improves (the measure goes up)		2 studies	135 people
Studies that measured kidney function Resveratrol may mildly improve renal function in the general adult population: A systematic review and meta-analysis of randomized controlled clinical trials.Nutr Res · PMID 36996691 Effects of resveratrol supplementation on renal function in adults: a systematic review and dose-response meta-analysis.Naunyn Schmiedebergs Arch Pharmacol · PMID 40580309
	Serum Albumin	Improves (the measure goes up)			516 people
	Uric Acid	Improves (the measure goes down)			353 people

Taurine

Blood Pressure: improves
Weight: improves
Exercise Tolerance: improves

Taurine: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Blood Pressure Small Improvement	Improves (the measure goes down)	Small effect	3 studies	29 people
Studies that measured blood pressure Two weeks taurine supplementation reverses endothelial dysfunction in young male type 1 diabeticsDiab Vasc Dis Res · PMID 20667936 Insights into the cardiovascular benefits of taurine: a systematic review and meta-analysis.Nutr J · PMID 39148075 Taurine Supplementation Lowers Blood Pressure and Improves Vascular Function in Prehypertension: Randomized, Double-Blind, Placebo-Controlled StudyHypertension · PMID 26781281
	Weight	Improves (the measure goes down)		1 study	29 people
Studies that measured weight Effect of taurine supplementation on exercise capacity of patients with heart failureJ Cardiol · PMID 21334852
	Exercise Tolerance	Improves (the measure goes up)			29 people
	Heart Rate	Improves (the measure goes down)			29 people

Creatine

Exercise Tolerance
Subjective Well-Being: improves

Creatine: outcomes studied for Heart Failure
Grade	Outcome	Effect	Studies	People
	Exercise Tolerance Mixed effect		3 studies	20 people
Studies that measured exercise tolerance Creatine supplementation for patients with COPD receiving pulmonary rehabilitation: a systematic review and meta-analysisRespirology · PMID 20497386 Effect of high-dose creatine therapy on symptoms of exercise intolerance in McArdle disease: double-blind, placebo-controlled crossover studyArch Neurol · PMID 11790236 Creatine therapy in myophosphorylase deficiency (McArdle disease): a placebo-controlled crossover trialArch Neurol · PMID 10891977
	Subjective Well-Being	Improves (the measure goes up)	3 studies	20 people
Studies that measured subjective well-being Effect of creatine supplementation and sleep deprivation, with mild exercise, on cognitive and psychomotor performance, mood state, and plasma concentrations of catecholamines and cortisolPsychopharmacology · PMID 16416332 Creatine supplementation, sleep deprivation, cortisol, melatonin and behaviorPhysiol Behav · PMID 17046034 Creatine supplementation improves muscle strength in patients with congestive heart failurePharmazie · PMID 16599263

Coenzyme Q10

Blood Flow: improves
Exercise Tolerance: improves
Left Ventricular Ejection Fraction: improves

Coenzyme Q10: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Blood Flow Small Increase	Improves (the measure goes up)	Small effect	2 studies	23 people
Studies that measured blood flow Coenzyme Q10 and exercise training in chronic heart failureEur Heart J · PMID 16882678 Effect of coenzyme Q10 administration on endothelial function and extracellular superoxide dismutase in patients with ischaemic heart disease: a double-blind, randomized controlled studyEur Heart J · PMID 17644511
	Exercise Tolerance	Improves (the measure goes up)		2 studies	89 people
Studies that measured exercise tolerance Coenzyme Q10 terclatrate and creatine in chronic heart failure: a randomized, placebo-controlled, double-blind studyClin Cardiol · PMID 21462215 A randomized trial of coenzyme Q10 in mitochondrial disordersMuscle Nerve · PMID 20886510
	Left Ventricular Ejection Fraction	Improves (the measure goes up)		1 study	41 people
Studies that measured left ventricular ejection fraction Coenzyme Q10 (CoQ10) in isolated diastolic heart failure in hypertrophic cardiomyopathy (HCM)Biofactors · PMID 19096110
	Heart Size	Changes; see studies			41 people
	Oxygen Uptake	Improves (the measure goes up)			23 people
	Quality of Life	Improves (the measure goes up)			41 people

Iron

6-Minute Walking Test Performance: improves
Hemoglobin: improves
All-Cause Mortality: improves

Iron: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	6-Minute Walking Test Performance Small Improvement	Improves (the measure goes up)	Small effect		5,205 people
	Hemoglobin	Improves (the measure goes up)		7 studies	748 people
Studies that measured hemoglobin Role of iron in the reduction of anemia among women of reproductive age in low-middle income countries: insights from systematic review and meta-analysis.BMC Womens Health · PMID 37069552 Oral iron supplementation and anaemia in children according to schedule, duration, dose and cosupplementation: a systematic review and meta-analysis of 129 randomised trials.BMJ Glob Health · PMID 36849195 Efficacy of daily versus intermittent oral iron supplementation for prevention of anaemia among pregnant women: a systematic review and meta-analysis.EClinicalMedicine · PMID 39114275 and 4 more on the Iron page
	All-Cause Mortality	Improves (the measure goes down)		1 study	5,205 people
Studies that measured all-cause mortality Comparative efficacy of intravenous and oral iron supplements for the treatment of iron deficiency in patients with heart failure: A network meta-analysis of randomized controlled trials.Pharmacol Res · PMID 35810949
	Cardiovascular Disease Mortality	Improves (the measure goes down)		1 study	5,205 people
Studies that measured cardiovascular disease mortality Intravenous iron therapy among patients with heart failure and iron deficiency: An updated meta-analysis of randomized controlled trials.Heliyon · PMID 37383191
	Exercise Capacity	Improves (the measure goes up)		1 study	5,205 people
Studies that measured exercise capacity Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trialsBMJ Open · PMID 29626044
	Ferritin	Improves (the measure goes up)			574 people
	Left Ventricular Ejection Fraction	Improves (the measure goes up)			115 people
	Quality of Life	Improves (the measure goes up)			5,205 people
	Risk of Hospitalization for Heart Failure	Improves (the measure goes down)			3,378 people

D-Ribose

Angina: improves
ATP Regeneration: improves
Exercise Capacity: improves

D-Ribose: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Angina Small Improvement	Improves (the measure goes up)	Small effect		20 people
	ATP Regeneration	Improves (the measure goes up)		2 studies	15 people
Studies that measured atp regeneration D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility studyEur J Heart Fail · PMID 14607200 Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humansAm J Physiol Regul Integr Comp Physiol · PMID 14660478
	Exercise Capacity	Improves (the measure goes up)		2 studies	251 people
Studies that measured exercise capacity Effects of ribose on exercise-induced ischaemia in stable coronary artery disease.Lancet · PMID 1354276 Effects of Ubiquinol and/or D-ribose in Patients With Heart Failure With Preserved Ejection Fraction.Am J Cardiol · PMID 35644694
	Atrial Contribution To Left Ventricular Filling	Improves (the measure goes up)			15 people
	Brain Natriuretic Peptide	Improves (the measure goes up)			216 people
	E wave deceleration time	Improves (the measure goes up)			15 people
	End-Systolic Volume	Improves (the measure goes up)			15 people
	Exercise Tolerance	Improves (the measure goes up)			35 people
	Glycogen Resynthesis	Improves (the measure goes up)			15 people
	Left Atrial Dimension	Improves (the measure goes up)			15 people
	Left Ventricular Diastolic Dimension	Improves (the measure goes up)			15 people
	Left Ventricular Ejection Fraction	Improves (the measure goes up)			231 people
	Quality of Life	Improves (the measure goes up)			231 people
	Vigor/Activity	Improves (the measure goes up)			216 people

Berberine

Exercise Tolerance
Quality of Life: improves

Berberine: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Exercise Tolerance No effect		NoneNo effect	1 study	156 people
Studies that measured exercise tolerance Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathyAm J Cardiol · PMID 12860219
	Quality of Life	Improves (the measure goes up)			156 people

Cocoa Extract

Heart Failure Risk
Mitochondrial Protection: improves

Cocoa Extract: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Heart Failure Risk No effect		NoneNo effect	1 study	106,109 people
Studies that measured heart failure risk Chocolate Consumption and Risk of Heart Failure: A Meta-Analysis of Prospective StudiesNutrients · PMID 28425931
	Mitochondrial Protection	Improves (the measure goes up)		1 study	5 people
Studies that measured mitochondrial protection Alterations in skeletal muscle indicators of mitochondrial structure and biogenesis in patients with type 2 diabetes and heart failure: effects of epicatechin rich cocoaClin Transl Sci · PMID 22376256

Omega-3 Fatty Acids

Cardiovascular Disease Mortality
Risk of Hospitalization for Heart Failure: improves

Omega-3 Fatty Acids: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	Cardiovascular Disease Mortality No effect		NoneNo effect	1 study	45,585 people
Studies that measured cardiovascular disease mortality The Effect of Omega-3 Supplementation on Heart Failure Outcome: A Meta-Analysis of Randomized Clinical Trial.J Lipid Atheroscler · PMID 38826182
	Risk of Hospitalization for Heart Failure	Improves (the measure goes down)			45,585 people

Thiamine (Vitamin B1)

6-Minute Walking Test Performance
Left Ventricular Ejection Fraction: improves
End-Diastolic Volume: improves

Thiamine (Vitamin B1): outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People
	6-Minute Walking Test Performance No effect		NoneNo effect		274 people
	Left Ventricular Ejection Fraction	Improves (the measure goes up)		1 study	274 people
Studies that measured left ventricular ejection fraction Role of Thiamine Supplementation in the Treatment of Chronic Heart Failure: An Updated Meta-Analysis of Randomized Controlled Trials.Clin Cardiol · PMID 38940395
	End-Diastolic Volume	Improves (the measure goes up)			274 people
	Heart Failure Class	Improves (the measure goes up)			274 people
	N-terminal Prohormone of Brain Natriuretic Peptide	Improves (the measure goes up)			274 people

Nitrate

Exercise Capacity: improves

Nitrate: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Exercise Capacity	Improves (the measure goes up)		5 studies	1,160 people
Studies that measured exercise capacity The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis.Sports Med · PMID 27600147 Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis.Br J Nutr · PMID 29553034 Factors that Moderate the Effect of Nitrate Ingestion on Exercise Performance in Adults: A Systematic Review with Meta-Analyses and Meta-Regressions.Adv Nutr · PMID 35580578 and 2 more on the Nitrate page

Vitamin C

Heart Rate: improves

Vitamin C: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Heart Rate	Improves (the measure goes down)		1 study	11 people

Terminalia Arjuna

Left Ventricular Ejection Fraction: improves

Terminalia Arjuna: outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Left Ventricular Ejection Fraction	Improves (the measure goes up)		1 study	12 people

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use. They are listed so the supplement evidence above can be read against them.

2 medicines and peptides

Nesiritide (Natrecor)

Pulmonary Capillary Wedge Pressure: improves
Dyspnea Improvement: improves
Systemic Vascular Resistance: improves

Nesiritide (Natrecor): outcomes studied for Heart Failure
Outcome	Effect	Size	Studies
Pulmonary Capillary Wedge Pressure Significant and sustained reduction in PCWP. VMAC trial showed greater PCWP reduction vs nitroglycerin at 3 hours (P=0.03).	Improves (the measure goes down)	Large effect	15 studies
Dyspnea Improvement VMAC trial: Greater improvement in dyspnea vs nitroglycerin at 3 hours. Rapid onset symptomatic relief in ADHF.	Improves (the measure goes up)	Large effect	15 studies
Systemic Vascular Resistance Balanced vasodilation with sustained SVR reduction without tachyphylaxis observed in clinical trials.	Improves (the measure goes down)	Moderate effect	15 studies
Cardiac Output Improved cardiac output secondary to afterload reduction. Comparable efficacy to dobutamine with better safety profile.	Improves (the measure goes up)	Moderate effect	15 studies
Global Clinical Status Improvement in global clinical status in trials, though long-term outcomes remain under study.	Improves (the measure goes up)	Moderate effect	16 studies

Elamipretide (Forzinity/SS-31)

LV End-Systolic Volume (HFrEF)

Elamipretide (Forzinity/SS-31): outcomes studied for Heart Failure
Grade	Outcome	Effect	Size	Studies	People	Studies list
	LV End-Systolic Volume (HFrEF) PROGRESS-HF Phase 2 (n=71): Elamipretide 4mg or 40mg daily x28 days did not improve LVESV vs placebo in stable HFrEF patients. Well tolerated but failed to meet primary endpoint.		NoneNo effect	10 studies

Key findings

Blood PressureCitrullineImproves (the measure goes down)
Blood Urea Nitrogen (BUN)ResveratrolImproves (the measure goes down)
Exercise ToleranceCreatine

The Heart Failure protocol

2 primary supplements · 6 supporting supplements

Coenzyme Q10100–300 mg daily (ubiquinol form preferred)
Omega-3 Fatty Acids1–4 g EPA/DHA daily (prescription strength shown beneficial)

See the full protocol

Shop the evidence-backed picks

Support alongside medical care. These supplements are not a treatment for Heart Failure. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.

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Studies cited

7 studies from PubMed

Safety, acceptance, and physiologic effects of sauna bathing in people with chronic heart failure: a pilot report.Arch Phys Med Rehabil · PMID 19154844
Beneficial effects of Waon therapy on patients with chronic heart failure: results of a prospective multicenter study.J Cardiol · PMID 18922381
Effects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure.Circ J · PMID 15564698
Improvement of autonomic nervous activity by Waon therapy in patients with chronic heart failure.J Cardiol · PMID 20884178
Effect of Waon therapy on oxidative stress in chronic heart failure.Circ J · PMID 21173495
Waon Therapy for Managing Chronic Heart Failure　- Results From a Multicenter Prospective Randomized WAON-CHF Study.Circ J · PMID 27001189
Neurohumoral Modulation During Waon Therapy in Chronic Heart Failure　- Subanalysis of Waon-CHF Study.Circ J · PMID 28202884