Abstract
Background: Heart failure as an important issue in global public health, has brought a heavy economic burden. Traditional Chinese medicine injections (TCMIs) have significant effects on heart failure with reduced ejection fraction (HFrEF). However, it is difficult for clinicians to identify the differences in clinical efficacy and safety of various TCMIs. The purpose of this study is to compare the efficacy and safety of various TCMIs for treating HFrEF by conducting a Bayesian network meta-analysis (NMA) and to further provide references for clinical decision-making. Methods: The clinical randomized controlled trials of TCMIs for treating HFrEF were searched in seven database from inception to August 3rd, 2021. The Cochrane collaboration’s tool was used to assess the risk of bias. NMA was performed in a Bayesian hierarchical framework. The surface under the cumulative ranking curve (SUCRA), the multi-dimensional efficacy analysis, the comparison-adjusted funnel plot, and the node-splitting analysis were conducted using R software. Results: A total of 107 eligible RCTs involving 9,073 HFrEF patients and 6 TCMIs were included. TCMIs include Huangqi injection (HQ) also called Astragalus injection, Shenfu injection (SF), Shengmai injection (SGM), Shenmai injection (SM), Xinmailong injection (XML), and Yiqifumai lyophilized injection (YQFM). The results of NMA and SUCRA showed that with conventional treatment (CT) as a common control, in terms of clinical efficacy, CT + XML was most effective in New York Heart Association cardiac functional classification efficiency, brain natriuretic peptide, and N-terminal pro-brain natriuretic peptide; the CT + SM was most effective in 6-min walking test, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac output; the CT + YQFM was most effective in left ventricular ejection fraction; the CT + HQ was most effective in stroke volume; the CT + SF was most effective in Minnesota Living with Heart Failure Questionnaire. In terms of safety, there was no significant difference between CT + TCMIs and CT. Conclusion: This Bayesian network meta-analysis results show that the combination of qualified TCMIs and CT is more effective for HFrEF patients than CT alone, and CT + XML and CT + SM may be one of the potential optimal treatments. Also, the safety of these TCMIs needs to be further observed. However, due to some limitations, the conclusions need to be verified by more large-sample, double-blind, multi-center RCTs.
Highlights
Heart failure (HF) is defined as a clinical syndrome, characterized by dyspnea, fatigue, fluid retention, etc., caused by a reduced cardiac output and/or elevated intracardiac pressures due to a structural and/or functional cardiac abnormality (Ponikowski et al, 2016)
The results of network meta-analysis (NMA) and surface under the cumulative ranking curve (SUCRA) showed that with conventional treatment (CT) as a common control, in terms of clinical efficacy, CT + Xinmailong injection (XML) was most effective in New York Heart Association cardiac functional classification efficiency, brain natriuretic peptide, and N-terminal pro-brain natriuretic peptide; the CT + Shenmai injection (SM) was most effective in 6-min walking test, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac output; the CT + Yiqifumai lyophilized injection (YQFM) was most effective in left ventricular ejection fraction; the CT + Huangqi injection (HQ) was most effective in stroke volume; the CT + Shenfu injection (SF)
This Bayesian network meta-analysis results show that the combination of qualified Traditional Chinese medicine injections (TCMIs) and CT is more effective for heart failure with reduced ejection fraction (HFrEF) patients than CT alone, and CT + XML and CT + SM may be one of the potential optimal treatments
Summary
Heart failure (HF) is defined as a clinical syndrome, characterized by dyspnea, fatigue, fluid retention, etc., caused by a reduced cardiac output and/or elevated intracardiac pressures due to a structural and/or functional cardiac abnormality (Ponikowski et al, 2016). It generally occurs in the terminal stage of various cardiovascular diseases, with high morbidity and mortality (Virani et al, 2020). The purpose of this study is to compare the efficacy and safety of various TCMIs for treating HFrEF by conducting a Bayesian network meta-analysis (NMA) and to further provide references for clinical decision-making
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