Clinical Efficacy and Safety of Chinese Herbal Medicine Combined with Western Medicine in the Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis
Authors: Zhang Wei, Li Na, Wang Fang, Chen Jing, Liu Yang
Background: Chronic heart failure (CHF) is a major public health burden with high morbidity and mortality. Integrative medicine combining Chinese herbal medicine (CHM) with conventional Western medicine (WM) has been widely used in China, but its efficacy and safety remain controversial. Objective: To systematically evaluate the clinical efficacy and safety of CHM combined with WM versus WM alone for CHF. Methods: We searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases from inception to October 2024 for randomized controlled trials (RCTs) comparing CHM+WM with WM alone in CHF patients. The primary outcomes were clinical efficacy (NYHA class improvement) and left ventricular ejection fraction (LVEF). Secondary outcomes included N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, 6-minute walk distance (6MWD), and adverse events. Meta-analysis was performed using RevMan 5.4. Results: A total of 18 RCTs involving 1,562 patients were included. Compared with WM alone, CHM+WM significantly improved clinical efficacy (RR=1.24, 95% CI 1.15-1.34, P<0.00001), increased LVEF (MD=4.12%, 95% CI 2.98-5.26, P<0.00001), reduced NT-proBNP (SMD=-0.85, 95% CI -1.12 to -0.58, P<0.00001), and improved 6MWD (MD=45.6 m, 95% CI 30.2-61.0, P<0.00001). No significant difference in adverse events was observed (RR=0.92, 95% CI 0.68-1.24, P=0.58). Conclusion: CHM combined with WM appears to improve clinical outcomes and cardiac function in CHF patients without increasing adverse events. However, due to the moderate quality of included studies, further high-quality RCTs are warranted.
