January 31, 2018BMC Complementary and Alternative MedicineOpen Access

Comparative efficacy of Chinese herbal injections for treating chronic heart failure: a network meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic heart failure (CHF) (n=9525). Intervention: Shenmai injection (SMI) or Shengmai injection (SI) vs. Western medicine (WM) alone. Primary outcome: Clinical effective rate (OR 0.25, 95% CI 0.17-0.36).

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Key result

Shenmai injection combined with western medicine significantly improved the clinical effective rate compared to western medicine alone (OR 0.25) in patients with chronic heart failure.

Why the study?

Does the addition of Chinese herbal injections to western medicine improve clinical effective rate and LVEF in patients with chronic heart failure?

Population

9,525 patients with chronic heart failure from 113 RCTs, majority middle aged and elderly, ~55% male, all…

Comparison

Chinese herbal injections added to standard… vs Standard western medicine alone or another…

Design

Meta-analysis, 113 randomized controlled trials included, 1 RCT utilized…

Authors

KWKai-Huan WangBeijing University of Chinese Medicine JWJiarui WuSouth China Agricultural University DZDan ZhangJiangnan University

Discussion

Member takes

Implication

Supports adjunctive Shenmai in chronic heart failure; extends network meta-analysis evidence for traditional Chinese medicine.

Study Design

Type

Meta-Analysis (n=9,525)

Structured PICO

Does the addition of Chinese herbal injections to western medicine improve clinical effective rate and LVEF in patients with chronic heart failure?

Population

9,525 patients with chronic heart failure from 113 randomized controlled trials in China, receiving western medicine combined with various Chinese herbal injections.

Intervention

Chinese herbal injections (Huangqi, Shenfu, Shengmai, Shenmai, Shenqi Fuzheng, or Yiqifumai injection) added to standard western medicine (ACEIs, beta-blockers, cardiotonics, diuretics).

Comparator

Standard western medicine alone (ACEIs, beta-blockers, cardiotonics, diuretics) or another Chinese herbal injection plus western medicine.

Outcome

Clinical effective rate (composite of clinical symptom relief and NYHA class improvement) and Left ventricular ejection fraction (LVEF).composite

Main Result

Odds Ratio: 0.25 (95% CI 0.17–0.36)

The addition of Shengmai or Shenmai injections to standard western medicine may improve clinical symptoms and left ventricular ejection fraction in patients with chronic heart failure.

Limitations

Enrolled patients in the included RCTs were exclusively Chinese, limiting generalizability to other populations.
Only 10 of the included RCTs reported 6-minute walk test (6MWT) results, which is a vital indicator of patient recovery.
The methodological quality of the included RCTs was generally low, with most not mentioning details of randomization and allocation concealment.
About 64% of the included trials did not report ADRs/ADEs
Small number of relevant RCTs and low statistical power for some outcomes like 6MWT
High risk of bias in many included RCTs due to insufficient information on randomization and blinding

Cite This Study

Wang et al. (2018) conducted a meta-analysis in Chronic heart failure (CHF) (n=9,525). Shenmai injection (SMI) or Shengmai injection (SI) vs. Western medicine (WM) alone was evaluated on Clinical effective rate (OR 0.25, 95% CI 0.17-0.36). Shenmai injection combined with western medicine significantly improved the clinical effective rate compared to western medicine alone (OR 0.25) in patients with chronic heart failure.

synapsesocial.com/papers/6a707594439bab0cabc32c74 https://doi.org/10.1186/s12906-018-2090-3

Topics

HFrEF treatment Heart failure

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Comparative efficacy of Chinese herbal injections for treating chronic heart failure: a network meta-analysis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Comparative efficacy of Chinese herbal injections for treating chronic heart failure: a network meta-analysis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider