Complementary Alternative Cardiovascular Medicine

2 Alternative Cardiovascular Medicine
about CAM and CVD?” and (3) How do I assess multiple reports and
studies on CAM and CVD for best evidence to provide effective and
sensitive patient counseling?
WHY THE NEED FOR A KNOWLEDGE BASE
REGARDING CAM?
A significant and growing percentage of our patients use some form
of CAM, making it a critically important aspect of the health care environment.
The surveys performed by Eisenberg and colleagues from
Harvard in 1990 (1) and again in 1997 (2) provided surprising data
concerning CAM. The investigators used telephone interviews to survey
English-speaking households in the United States. They defined CAM
as medical interventions not taught widely at US medical schools or
generally available at US hospitals. They found that the percentage of
the US population estimated to be currently using at least one CAM
therapy, either independently or through practitioners, was 34% in 1990
and 42% in 1997 (a 25% increase). If we extrapolate this data trend to
today, we are at or beyond the point where most of our patients are
currently using some form of CAM. Equally important is the finding that
most (72% of the people using CAM in the 1997 Eisenberg survey) did
not share this information with their physicians.
Wootton and Sparber (3) reviewed six national surveys performed
from 1990 to 2000 and found that the Eisenberg data were supported by
the findings of a large market survey sponsored by Landmark Health
Care Inc. (4) and in a survey by Astin (5) of a randomly drawn subsample
of the National Family Opinion survey performed in 1994. Other studies
performed during this same time period have reported smaller percentages
of the populations using CAM. The differing percentages likely
relate, in part, to the structure of the surveys and the questions. In one
such large random survey, CAM was defined as unconventional therapies
and the questions were restricted to the use of practitioner-directed
therapies as opposed to self-care (6).
The sociodemographic characteristics of patients who are most likely
to use CAM note a small preponderance of women vs men and greater
use in middle-aged, higher educated, and higher income populations.
However, these findings may reflect sampling issues, because smaller
studies that have focused on underserved populations note a similar high
percentage of CAM use as reported in higher socioeconomic groups.
Liu and colleagues surveyed 376 consecutive patients admitted for
cardiovascular surgery to Columbia University–New York Presbyterian
Hospital (7). They obtained a 70% response rate and noted that 77% of the