Qili Qiangxin capsule as adjunctive therapy for heart failure after acute myocardial infarction: a GRADE-assessed systematic review and meta-analysis of randomised controlled trials

Background Heart failure (HF) after acute myocardial infarction (AMI) remains a major cause of morbidity and mortality despite advances in conventional therapy. Qili Qiangxin Capsule (QLQX) has been widely used as an adjunctive treatment for HF in China, but its efficacy and safety in patients with HF after AMI require further evaluation. Methods Seven databases were searched from their inception to January 2026. Randomised controlled trials (RCTs) comparing QLQX plus conventional Western medicine (WM) with WM alone were included. The primary outcome was N-terminal pro-B-type natriuretic peptide (NT-proBNP). Secondary outcomes included left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), clinical response rate, high-sensitivity C-reactive protein (hs-CRP), quality of life, all-cause mortality, heart failure-related hospitalisation, and adverse events. Meta-analysis was performed using RevMan 5.4. Results A total of 16 RCTs involving 1391 participants were included. Compared with WM alone, QLQX plus WM was associated with greater reductions in NT-proBNP, BNP, LVEDD, LVESD, and hs-CRP, and improving LVEF, quality of life and the clinical response rate. No statistical differences were observed in LVEDV, all-cause mortality, and adverse events. Heart failure-related hospitalisation was not reported in any included study. The certainty of evidence for all outcomes was rated as low or very low according to the GRADE approach. Conclusion QLQX plus conventional WM was associated with improvements in several surrogate and short-term clinical outcomes in patients with HF after AMI. However, the certainty of evidence was low or very low, and data on mortality and heart failure-related hospitalisation were insufficient. The current evidence is therefore inadequate to determine whether QLQX improves long-term clinical prognosis. Further high-quality RCTs with longer follow-up and clinically important endpoints are needed. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261277047 , identifier CRD420261277047.