Improved medical expenditure and survival with integration of traditional Chinese medicine treatment in patients with heart failure: A nationwide population-based cohort study.

Ming-Yen Tsai,Wen-Long Hu,Yu-Chuen Huang,Yu-Chiang Hung,Jen-Huai Chiang,Shih-Yu Chen,Yung-Hsiang Chen

doi:10.18632/oncotarget.20063

Abstract

BackgroundNo previous studies have evaluated the effects of traditional Chinese medicine (TCM) treatment on patients with heart failure (HF). Hence, in this study, we determined whether TCM treatment affects the healthcare burden and survival of HF patients.MethodsSamples were retrieved from the registry of catastrophic illness patients of the Taiwan National Health Insurance Research Database (NHIRD). Based on a frequency (1:1) matched case-control design, patients with HF between 2000 and 2010 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with HF was analyzed.ResultsAmong these patients, 312 used TCM for HF treatment and exhibited significantly increased 5-year survival (p < .0001), with multivariate adjustment, compared with those without TCM use. Mean outpatient clinic visits at 1 year and 5 years after HF diagnosis were higher in TCM users, and accumulated medical costs were lower than in non-TCM users at 1 year. The hospitalization cost at 1-year follow-up was lower for TCM users than for non-TCM users. We found that, compared with non-TCM users, TCM users had an 86% reduction in risk of mortality in the compensated group, and a 68% reduction in the decompensated group receiving TCM treatment (aHR 0.32, 95% CI 0.20–0.52). The hazard ratio (HR) of Chinese herbal medicine (CHM) users with HF was significantly lower than that of non-users (aHR 0.24, 95% CI 0.16–0.35). We also analyzed the most commonly used herbal products as well as the HRs associated with their use, thus providing future research avenues.ConclusionsThis nationwide retrospective cohort study finds that combined therapy with TCM may improve survival in HF patients. This study also suggests that TCM may be used as an integral element of HF interventions on health care costs.

Highlights

Heart failure (HF) is a common cause of morbidity and mortality [1,2,3]
From 2000 to 2010, 312 subjects met the criterion of traditional Chinese medicine (TCM) use for heart failure (HF) and were defined as TCM users, and an equal number of matched subjects were classified as non-TCM users. (Figure 1)
The incidences of diabetes mellitus and stroke were higher in non-TCM users

Summary

Introduction

Heart failure (HF) is a common cause of morbidity and mortality [1,2,3]. The prevalence of HF is increasing worldwide due to both an aging population and significant advances in the management of associated comorbidities, such as ischemic heart disease, arrhythmia, diabetes mellitus, stroke, and hypertension [4, 5]. Due to dissatisfaction with conventional western medication in treating HF [10], more and more HF patients are turning to complementary and alternative medicine (CAM) to improve the symptoms and signs of the disease [11]. Traditional Chinese medicine (TCM) is regarded as a CAM therapy in Western countries [12, 13]. It is a mainstream therapy in some Asian countries, such as Taiwan, Korea, and China. No previous studies have evaluated the effects of traditional Chinese medicine (TCM) treatment on patients with heart failure (HF). In this study, we determined whether TCM treatment affects the healthcare burden and survival of HF patients

Methods

Results

Conclusion