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Oral Chinese Herbal Medicine for Heart Failure with Preserved Ejection Fraction: A Meta-Analysis

  • Evidence-Based Integrative Medicine
  • Published:
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Abstract

Objective

To evaluate the effectiveness and safety of oral Chinese herbal medicine (OCHM) for heart failure with preserved ejection fraction (HFpEF).

Methods

PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Chinese Biological Medicine Database (CBM), Wanfang Database, Chongqing VIP Information (VIP) and China National Knowledge Infrastructure (CNKI) were searched for appropriate articles from respective inceptions until June 3, 2018. Randomized controlled trials (RCTs) investigating the effectiveness of OCHM for the patients with HFpEF were eligible. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool. Papers were independently reviewed by two reviewers and analyzed using Cochrane software Revman 5.3. Dichotomous data were analyzed by relative risk (RR) with a 95% confidence interval (CI), while continuous variables were analyzed by using mean difference (MD) with 95% CI for effect size.

Results

A total of 16 RCTs involving 1,320 participants were identified. Fourteen of the trials used conventional Western medicine (CWM) as the control, the control of 1 trial was no treatment, and another was placebo. Three of the trials served Chinese patent medicine (CPM) as interventions, and other OCHM were Chinese medicine decoctions (CMDs). Only limited evidence showed experimental group with OCHM may get better effect on brain natriuretic peptide (BNP: MD -37.29, 95% CI -53.08 to -21.50, P<0.00001) or N terminal pro B type natriuretic peptide (NT-proBNP: MD -236.04, 95% CI -356.83 to -115.25, P=0.0001), Minnesota Living with Heart Failure questionnaire (MLHFQ, MD -9.94, 95% CI -16.77 to -3.11, P=0.004), but the results had high heterogeneities. With concerns on 12 of 16 trials, the meta-analysis found that the adjuvant therapy of OCHM might be more effective in increasing overall response rate (RR 1.17, 95% CI 1.11 to 1.24, P<0.00001), when compared with CWM alone. Subgroup meta-analysis between CPMs and CMDs showed that the two CPMs may have more therapeutic effect on MLHFQ, but not on NT-proBNP, and CMD came to the opposite conclusion. No significant differences were found between experimental groups and control groups on 6-min walk test (6MWT). Adverse events, such as more defecation, weakness, cardiopalmus, edema, cough and hypotension, were mild in all groups and disappeared after the easement of pharmacological intervention.

Conclusions

Due to the insufficient quality of trials that were analyzed, it is not appropriate to confirm or deny the potency of OCHMs in treating HFpEF at the present time. More rigorously designed RCTs focusing on primary endpoints with long-term follow-up are warranted to validate the effect of OCHMs for patients with HFpEF.

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Author information

Authors and Affiliations

  1. Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China

    Jun Mei & Jian-qing Ju

  2. Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China

    Hao Xu

  3. Geriatric Institution, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China

    Feng-qin Xu

Authors
  1. Jun Mei
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  2. Hao Xu
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  3. Feng-qin Xu
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  4. Jian-qing Ju
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Contributions

Xu FQ conceived the topic and helped to draft the manuscript. Mei J and Ju JQ collected the references and wrote the manuscript. The submission and revision of manuscript were completed by Xu FQ and Xu H.

Corresponding author

Correspondence to Feng-qin Xu.

Additional information

Supported by the National Natural Science Foundation of China (No. 81473529) and the Fundamental Research Funds for the Central Public Welfare Research Institutes (No. 220808043)

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Mei, J., Xu, H., Xu, Fq. et al. Oral Chinese Herbal Medicine for Heart Failure with Preserved Ejection Fraction: A Meta-Analysis. Chin. J. Integr. Med. 25, 770–777 (2019). https://doi.org/10.1007/s11655-019-2704-8

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  • DOI: https://doi.org/10.1007/s11655-019-2704-8

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