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We welcome McKenzie and Cowley’s update on drug therapy in chronic heart failure.1 Interestingly, they fail to mention hawthorn (Crataegus) extract as a possible additional treatment option for this condition. We would like to draw readers’ attention to our recent meta-analysis, which suggests a significant increase in maximal workload and an improvement of heart failure related symptoms compared with placebo in New York Heart Association stage II patients.2 Hawthorn extract seems to be safer than many other drugs for this indication. Trial patients reported only mild and infrequent adverse events even on very high doses of hawthorn extract. This implies that its therapeutic window is relatively wide.