Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis

Q: What are the key findings of this study?

Adjunctive traditional Chinese medicine injections improved LVEF in ischemic heart failure vs conventional therapy alone, led by Shenmai injection (MD 9.63, 95% CI 7.67-11.60; SUCRA 97.2%).

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Ischemic heart failure (n=13756). Intervention: Six traditional Chinese medicine injections (Shenmai, Shengmai, Shenfu, Xinmailong, Huangqi, and Yiqifumai injections) plus conventional treatment vs. Conventional treatment alone (ARNIs, ACEIs, ARBs, beta-blockers, diuretics, MRAs, SGLT2is, antiplatelets, nitrates, statins, digitalis). Primary outcome: Left ventricular ejection fraction (LVEF) improvement (for top-ranked Shenmai injection plus conventional treatment vs conventional treatment alone) (MD 9.63, 95% CI 7.67-11.60, p=<0.05).

Q: What does this research mean for the field?

Adjunctive traditional Chinese medicine injections combined with conventional therapy improve clinical effectiveness and cardiac function in ischemic heart failure without increasing short-term adverse events, though certainty of evidence is low to very low. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate and compare the efficacy and safety of six traditional Chinese medicine injections as adjuvant therapy to conventional treatment for ischemic heart failure.

Yu Shang; Penglu Wei; Yue Mao; Jinhao Tian; Xiaolei Lai; Wenlong Xing; Juju Shang; Hongxu Liu

doi:10.3389/fcvm.2026.1969858

October 30, 2026Frontiers in Cardiovascular MedicineOpen Access

Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis

View Full Paper

Ask AI

Bookmark

Share

Key result

Adjunctive Shenmai injection boosts LVEF by ~10 points over conventional therapy in ischemic heart failure.

MD +9.63
95% CI 7.67-11.60
P<0.05
n=13,756

Why the study?

Traditional Chinese medicine injections are widely used as adjuvant therapy for ischemic heart failure, prompting a comparison of the efficacy and safety of six specific injections added to conventional treatment.

Do six traditional Chinese medicine injections added to conventional treatment improve clinical effectiveness, cardiac function, biomarkers, and exercise capacity in patients with ischemic heart failure?

Key Points

To evaluate and compare the efficacy and safety of six traditional Chinese medicine injections as adjuvant therapy to conventional treatment for ischemic heart failure.
Eight databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, the Cochrane Library, and Web of Science) were searched from inception to May 6, 2026, for randomized controlled trials.
Identified 154 randomized controlled trials comprising 13,756 participants evaluating conventional treatment alone versus conventional treatment plus one of six traditional Chinese medicine injections administered for at least 7 days.
Assessed risk of bias with RoB 2.0, evaluated evidence certainty using CINeMA, and performed Bayesian network meta-analyses using R 4.6.0 and Stata 17.0.
Adjunctive traditional Chinese medicine injections generally improved clinical response rates and left ventricular ejection fraction while reducing B-type natriuretic peptide and left ventricular end-diastolic dimension compared with conventional treatment alone; effects on NT-proBNP remained uncertain.
Based on SUCRA rankings, Shenmai injection ranked highest for clinical effectiveness rate and left ventricular ejection fraction, Shengmai injection for BNP, Xinmailong injection for NT-proBNP, Yiqifumai injection for LVEDD, and Shenfu injection for 6-minute walking distance.
Short-term adverse-event rates were not increased overall, but confidence in relative rankings is limited by low or very low certainty of evidence, substantial heterogeneity, and the lack of direct head-to-head trials.

Study Design

Type

Meta-Analysis (n=13,756)

Randomization

Randomized controlled trials included

Structured PICO

Do six traditional Chinese medicine injections added to conventional treatment improve clinical effectiveness, cardiac function, biomarkers, and exercise capacity in patients with ischemic heart failure?

P

Population

13,756 patients with confirmed ischemic heart failure across 154 randomized controlled trials receiving adjunctive traditional Chinese medicine injections plus conventional treatment for 7 to 90 days.

I

Intervention

Six traditional Chinese medicine injections (TCMIs) administered as adjuncts to conventional treatment (CT) for 7 to 90 days (no less than 7 days): Shenfu injection (SFI, 42 RCTs, n=3,178, 7-90 days), Shenmai injection (SMI, 34 RCTs, n=3,471, 7-90 days), Shengmai injection (SHMI, 19 RCTs, n=1,701, 7-21 days), Huangqi injection (HQI, 8 RCTs, n=751, 10-28 days), Xinmailong injection (XMLI, 26 RCTs, n=2,373, 7-14 days), and Yiqifumai injection (YQFMI, 25 RCTs, n=2,282, 7-30 days).

C

Comparator

Conventional treatment (CT) alone, including angiotensin receptor-neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers, diuretics, mineralocorticoid receptor antagonists (MRAs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), antiplatelet drugs, nitrates, statins, and digitalis preparations.

O

Outcome

Clinical effectiveness rate (CER, defined by symptom relief and cardiac function grade improvement) and left ventricular ejection fraction (LVEF) over 7 to 90 days of treatment.surrogate

Main Result

Mean Difference: 9.63 (95% CI 7.67–11.6)

p-value: p=<0.05

This Bayesian network meta-analysis of 154 RCTs suggests that adding traditional Chinese medicine injections to conventional heart failure therapy improves short-term LVEF, BNP, and clinical symptoms in ischemic heart failure without increasing short-term adverse events, though certainty of evidence is low to very low.

Limitations

Low or very low certainty of evidence across comparisons according to CINeMA
Substantial heterogeneity for continuous outcomes including BNP, NT-proBNP, LVEF, LVEDD, and 6MWT
Absence of direct head-to-head RCTs comparing different traditional Chinese medicine injections (no closed loops in the network)
Potential publication bias and small-study effects due to underreporting of negative results
Lack of long-term safety follow-up
Low or very low certainty of evidence across all comparisons per CINeMA assessment
Substantial heterogeneity for BNP (I² = 97.00%), NT-proBNP (I² = 97.60%), LVEF (I² = 99.70%), LVEDD (I² = 99.80%), and 6MWT (I² = 94.40%)
Absence of direct head-to-head RCTs and closed loops in the evidence network
Potential publication bias and small-study effects due to underreporting of negative results and scarcity of large-scale RCTs
Lack of long-term safety and efficacy follow-up

Implication

May improve LVEF with TCM adjuncts in ischemic HF; extends RCT network evidence but low certainty precludes practice change.

Abstract

Background Traditional Chinese medicine injections (TCMIs) are widely employed by Chinese clinicians as adjuvant therapy for Ischemic Heart Failure(IHF). A Bayesian network meta-analysis was conducted to compare the efficacy and safety of conventional treatment (CT) to those that included six TCMIs in patients with IHF. Objective To compare the efficacy and safety of six TCMIs as adjuncts to CT for IHF using Bayesian network meta-analysis. Methods Eight databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, the Cochrane Library, and Web of Science) were searched from inception to May 6, 2026, for randomized controlled trials (RCTs). Risk of bias was assessed using RoB 2.0, certainty of evidence using CINeMA, and Bayesian analyses using R 4.6.0 and Stata 17.0. Results A total of 154 RCTs involving 13,756 participants were included. Compared with CT alone, adjunctive TCMIs generally improved clinical response and left ventricular ejection fraction(LVEF), and reduced B-type natriuretic peptide(BNP) and left ventricular end-diastolic dimension(LVEDD); effects on N-terminal pro-B-type natriuretic peptide(NT-pro BNP) were uncertain. Surface under the cumulative ranking curve(SUCRA) estimates Shenmai injection(SMI) had the highest probability of ranking favorably for clinical effectiveness rate(CER) and left ventricular ejection fraction(LVEF), Shengmai injection(SHMI) for B-type natriuretic peptide(BNP), Xinmailong injection(XMLI) for N-terminal pro-B-type natriuretic peptide(NT-pro BNP), Yiqifumai injection(YQFMI) for left ventricular end-diastolic dimension(LVEDD), and Shenfu injection(SFI) for 6-minute walking distance(6MWT). Short-term adverse-event rates were not increased overall. Conclusion TCMIs combined with CT has potential benefits in the treatment of IHF, but confidence in treatment rankings is limited by low or very low certainty of evidence, substantial heterogeneity for several outcomes, methodological limitations, and the absence of direct head-to-head trials. Large, rigorously designed RCTs with long-term safety follow-up are required. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier (CRD 420261380716).

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Shang et al. (2026) conducted a meta-analysis in Ischemic heart failure (n=13,756). Six traditional Chinese medicine injections (Shenmai, Shengmai, Shenfu, Xinmailong, Huangqi, and Yiqifumai injections) plus conventional treatment vs. Conventional treatment alone (ARNIs, ACEIs, ARBs, beta-blockers, diuretics, MRAs, SGLT2is, antiplatelets, nitrates, statins, digitalis) was evaluated on Left ventricular ejection fraction (LVEF) improvement (for top-ranked Shenmai injection plus conventional treatment vs conventional treatment alone) (MD 9.63, 95% CI 7.67-11.60, p=<0.05). Adjunctive traditional Chinese medicine injections improved LVEF in ischemic heart failure vs conventional therapy alone, led by Shenmai injection (MD 9.63, 95% CI 7.67-11.60; SUCRA 97.2%).

synapsesocial.com/papers/6ae682bde432e7a5c4ef371a https://doi.org/10.3389/fcvm.2026.1969858

View Full Paper

Ask AI

Bookmark

Share

Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Comparative efficacy and safety of six traditional Chinese medicine injections for ischemic heart failure: a systematic review and Bayesian network meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading