Melatonin Supplementation in Heart Failure

Patient Selection and Management

• The European Society of Cardiology recommends exercise caution or avoid melatonin in patients with severe (NYHA class IV) heart failure, recent heart failure exacerbation or hospitalization within 4 weeks, or significant bradycardia (heart rate <60/min) 1, 2
• The American College of Cardiology suggests using melatonin as adjunctive therapy, not as a replacement for established heart failure treatments, including ACE inhibitors or ARBs, beta-blockers, SGLT2 inhibitors, mineralocorticoid receptor antagonists, and diuretics 1, 2, 3, 4, 5, 6

Guideline-Directed Medical Therapy

• The American College of Cardiology recommends ACE inhibitors or ARBs as first-line therapy for all NYHA class I-IV patients unless contraindicated 1, 2, 3
• The American College of Cardiology suggests beta-blockers have a proven mortality benefit (bisoprolol, carvedilol, or metoprolol CR/XL) 1, 2
• The American College of Cardiology recommends SGLT2 inhibitors for HFrEF to reduce morbidity and mortality 4, 5
• The American College of Cardiology suggests mineralocorticoid receptor antagonists for appropriate candidates 4
• The European Society of Cardiology recommends diuretics as needed for congestion management 4, 6