The investigators propose a double-blind, placebo-controlled, randomized clinical trials of a standardized Crataegus (Hawthorn) extract in patients who, despite optimal conventional medical therapy, continue to experience symptomatic heart failure. Crataegus oxycantha (Hawthorn), an over-the-counter herbal adjunctive treatment for heart failure, has inotropic, vasodilator anti- arrhythmic and antioxidant activity. The goal is to obtain a comprehensive understanding of the potential role of hawthorn in the treatment of heart failure. One hundred eighty patients will be randomized with equal allocations to one or two doses of Crataegus or to placebo, and will be followed for one year of changes in heart failure--specific QOL (Minnesota Living with Heart Failure Questionnaire) and sub-maximal exercise performance (six-minute walk distance). Secondary end-points will include changes in physician and patient global assessment with clinical status, peak exercise oxygen consumption, LV ejection fraction, neural hormones and mortality risk (heart failure survival score), cardiovascular and total hospitalizations and hospital costs, and cardiovascular and total mortality.
