Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2024; 12(4): 766-776
Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.766
Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis
Li-Li Xia, Shu-Yun Yang, Jun-Yao Xu, Han-Qing Chen, Zhu-Yuan Fang
Li-Li Xia, Shu-Yun Yang, Jun-Yao Xu, Zhu-Yuan Fang, Hypertension Research Institute, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210004, Jiangsu Province, China
Han-Qing Chen, Department of General Practice, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, Jiangsu Province, China
Author contributions: Xia LL and Fang ZY proposed the concept of this study; Yang SY contributed to data collection; Xia LL and Xu JY drafted the first draft; Chen HQ contributed to the formal analysis of this study; Fang ZY conducted guiding research, methodology, and visualization; all authors participated in this study, validated the study, and jointly reviewed and edited the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhu-Yuan Fang, MD, Chief Physician, Hypertension Research Institute, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210004, Jiangsu Province, China. fangzhuyuan@njucm.edu.cn
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: December 18, 2023
Revised: December 25, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 6, 2024
Processing time: 55 Days and 22.8 Hours
Abstract
BACKGROUND

Heart failure (HF), a common cardiovascular condition, is characterized by significant morbidity and mortality. While traditional Chinese medicine (TCM) is often used as a complementary approach in HF management, systematic evaluations of its impact on clinical outcomes, TCM syndrome scores, and B-type natriuretic peptide (BNP) levels are lacking. This study fills this gap through a comprehensive analysis of randomized controlled trials (RCTs) focusing on TCM for HF treatment. It encompasses an assessment of methodological quality, a meta-analysis, and an evaluation of evidence quality based on established standards. The results offer crucial insights into the potential advantages and constraints of TCM in HF management.

AIM

To systematically analyze the effects of TCM on the clinical comprehensive outcomes, TCM syndrome scores, and BNP levels in patients with HF and evaluated the quality of evidence for these trials.

METHODS

RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases, including China National Knowledge Infrastructure, Wanfang, VIP Information Chinese Science and Technology Journal, and PubMed. Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool, and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software. Finally, the quality of evidence was rated according to the GRADE criteria.

RESULTS

A total of 1098 RCTs were initially retrieved. After screening, 16 RCTs were finally included in our study, which were published between 2020 and 2023. These RCTs involved 1660 HF patients, including 832 in the TCM group [TCM combined with conventional Western medicine (CMW) treatment] and 828 in the CWM group (CWM treatment). The course of treatments varied from 1 wk to 3 months. TCM syndrome differentiation was analyzed in 11 of the included RCTs. In all included RCTs, outcome indicators included comprehensive clinical outcomes, TCM syndrome scores, and BNP levels. The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes [risk ratio = -0.54; 95% confidence interval (CI) = -0.61, -0.47; P < 0.00001], TCM syndrome scores [weighted mean difference (WMD) = -142.07; 95%CI = -147.56, -136.57; P < 0.00001], and BNP levels (WMD = -142.07; 95%CI = -147.56, -136.57; P < 0.00001). According to the GRADE criteria, RCTs where "TCM improves clinical comprehensive outcomes" were rated as low-quality evidence, and RCTs where "TCM reduces TCM syndrome scores" or "TCM decreases BNP levels" were rated as medium-quality evidence.

CONCLUSION

TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients. Given the low and medium quality of the included RCTs, the application of these results should be cautious.

Keywords: Traditional Chinese medicine; Heart failure; Comprehensive clinical outcomes; Traditional Chinese medicine syndrome score; B-type natriuretic peptide level; Meta-analysis

Core Tip: This study evaluated the effects of traditional Chinese medicine (TCM) on heart failure (HF) patients by analyzing randomized controlled trials (RCTs). The meta-analysis results showed that TCM combined with conventional Western medicine treatment improved comprehensive clinical outcomes, reduced TCM syndrome scores, and decreased B-type natriuretic peptide levels. However, caution should be exercised due to the low and medium quality of the included RCTs. TCM shows promise as a complementary therapy for HF, but further high-quality research is needed to confirm its effectivenes.