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Shengmai (a traditional Chinese herbal medicine) for heart failure

  • Review
  • Intervention

Authors

  • Jie Chen,

    1. West China Hospital, Sichuan University, Department of Evidence-Based Medicine and Clinical Epidemiology, Chengdu, Sichuan, China
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  • Yu Yao,

    1. West China Hospital, Sichuan University, Department of Endocrinology and Metabolism, Chengdu, China
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  • Haining Chen,

    1. West China Hospital, Sichuan University, Department of Gastrointestinal Surgery, Chengdu, China
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  • Joey SW Kwong,

    1. The Chinese University of Hong Kong, Division of Cardiology & Heart Education And Research Training (HEART) Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, & Institute of Vascular Medicine, Shatin, New Territories, Hong Kong
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  • Jin Chen

    Corresponding author
    1. West China Hospital, Sichuan University, Department of Evidence-Based Medicine and Clinical Epidemiology, Chengdu, Sichuan, China
    • Jin Chen, Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China. ebm_chenjin@126.com.

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Abstract

Background

This systemic review is an update of a review previously published in 2011. Heart failure is a major public health problem worldwide. Shengmai (a traditional Chinese herbal medicine) has long been used as a complementary treatment for heart failure in China.

Objectives

To assess the effects (both benefits and harms) of Shengmai for heart failure.

Search methods

We searched CENTRAL and DARE on The Cochrane Library (2011, Issue 1), MEDLINE (1948 to March 2011), EMBASE (1980 to March 2011), AMED (1985 to August 2008) (AMED was not searched for the update as it is no longer available to the person conducting the searches), BIOSIS (1969 to March 2011), CBM (1978 to April 2011), VIP (1989 to April 2011) and CNKI (1979 to April 2011). We also handsearched Chinese journals. No language restrictions were applied.

Selection criteria

Randomized controlled trials (RCTs) of Shengmai plus usual treatment versus usual treatment alone or Shengmai versus placebo in treating heart failure, irrespective of blinding status, were included. More stringent inclusion criteria were applied in this update and only studies with a clear description of randomization methods and classified as true RCTs were included.

Data collection and analysis

Two authors independently selected trials, assessed methodological quality and extracted data. Dichotomous and continuous data were calculated as relative risk (RR) and mean difference (MD) or standardized mean difference (SMD), respectively. A random-effects model and fixed-effect model were used to perform meta-analysis with and without heterogeneity, respectively.

Main results

Nine RCTs (600 patients) with seven comparing Shengmai plus usual treatment with usual treatment alone and three comparing Shengmai with placebo (one RCT contained three arms) were included in this updated review. Based upon the seven RCTs (494 patients), improvement of the New York Heart Association (NYHA) functional classification was more common in patients taking Shengmai plus usual treatment than in those receiving usual treatment alone (risk ratio 0.33, 95% confidence interval 0.23 to 0.47). Beneficial effects of Shengmai in treating heart failure were also observed on other outcomes, including an exercise test, ejection fraction, cardiac output, cardiac index and left ventricular end-systolic volume. The three RCTs (106 patients) which compared Shengmai with placebo reported an improvement in NYHA functional classification, ejection fraction, stroke volume, cardiac index and myocardial contractility. Three out of the nine RCTs reported mild adverse effects, and two patients were withdrawn due to the adverse effects. The results of this review should be interpreted with caution. This is due to the studies being of low quality, their small sample size, and the significant heterogeneity for certain outcomes including ejection fraction and cardiac output.

Authors' conclusions

Shengmai may be beneficial in treating heart failure, especially in terms of improving the NYHA functional classification with Shengmai plus usual treatment. However, the evidence for its effects on mortality and hospitalisation are not available yet. Therefore more studies, of higher quality and long-term follow-up, are needed to provide more evidence for the future use of Shengmai.

Plain language summary

Shengmai (a traditional Chinese herbal medicine) for heart failure

Heart failure is a major health problem worldwide and despite advances in treatment the number of deaths continues to rise. Shengmai is a traditional Chinese herbal medicine which has long been used to treat heart failure and ischemic heart disease. It is a medicine made up of the extract from the three herbs Panax ginseng, Ophiopogon japonicus and Schisandra chinensis. This review looked at nine studies which compared either Shengmai in addition to usual treatment or Shengmai to usual treatment or placebo, repectively. We found there was some evidence to show that Shengmai may improve heart function in patients with heart failure, although some minor adverse effects were reported. However, these results should be viewed with caution due to the poor quality and small sample size of the trials as well as the heterogeneity of particular outcomes, such as cardiac output and ejection fraction. The effect of Shengmai in treating heart failure must be determined in a properly controlled clinical trial.

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