Phosphocreatine in Congestive Heart Failure: Evidence Overview

Phosphocreatine (also known as creatine phosphate) is a compound involved in rapid energy production in cardiac and skeletal muscle. Its potential use in congestive heart failure (CHF) is based on the idea that failing hearts have impaired energy metabolism, and supplementation with phosphocreatine might help improve cardiac energetics.

Several small clinical studies and meta-analyses have explored intravenous phosphocreatine as an adjunctive therapy in CHF. Some studies have reported modest improvements in cardiac function, exercise tolerance, and arrhythmia reduction when phosphocreatine is administered, particularly in acute or perioperative settings. However, these studies are often limited by small sample sizes, short duration, and varying methodologies. Meta-analyses (e.g., Gong et al., 2012; Balestrino, 2016) suggest possible short-term benefits, but overall evidence remains of low to moderate quality, with a lack of large, well-controlled randomized trials.

Phosphocreatine is not currently recommended in major heart failure treatment guidelines. Its use is primarily supported by a mechanistic rationale and preliminary clinical data, rather than robust, high-quality clinical evidence. Thus, while there is some scientific validation for its use, particularly in acute settings, the evidence base is limited and does not support routine use in chronic CHF management.