The China PEACE Collaborative Group: NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Central China Subcenter of the National Center for Cardiovascular Diseases Henan People's Republic of China.
J Am Heart Assoc. 2019 Aug 6;8(15):e012776. doi: 10.1161/JAHA.119.012776. Epub 2019 Jul 31.
Background Traditional Chinese medicine (TCM) is used in the treatment of many conditions, including heart failure (HF), although it is not well characterized. Methods and Results We conducted a retrospective analysis of TCM use in a random sample of hospitalizations for HF within a random sample of Western medicine hospitals in China in 2015 using data from the China PEACE 5r-HF (China Patient-Centered Evaluative Assessment of Cardiac Events 5 Retrospective Heart Failure Study). We describe the frequency of TCM use and its association with patient characteristics, in-hospital use of evidence-based therapies, and hospital characteristics using hierarchical logistic regression models. Finally, we assessed risk-adjusted in-hospital bleeding and mortality. Among 10 004 patients hospitalized with HF (median age, 73 years; 48.9% women) from 189 hospitals, 74.7% received TCM (83.3% administered intravenously). The most commonly used agent was Salvia miltiorrhiza (51.2%). Patients with coronary artery disease (odds ratio [OR], 1.73; 95% CI, 1.53-1.95) or stroke (OR, 1.32; 95% CI, 1.15-1.51) were more likely to receive TCM; there was no correlation with evidence-based therapy use. Nearly all hospitals (99.4%) used TCM, with substantial variation across hospitals (median OR, 3.29; 95% CI, 2.82-3.76). In-patient bleeding (OR, 1.39; 95% CI, 1.03-1.88) and mortality (OR, 1.36; 95% CI, 1.04-1.79) were higher with Salvia miltiorrhiza, although not with other TCMs. Conclusions In a nationally representative sample of patients hospitalized with acute HF in China, three fourths received TCM. Nearly all hospitals used TCM, although use varied substantially by hospital. Although TCM was not used in lieu of evidence-based therapies for HF, we found a signal for harm with the most commonly used TCM. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02877914.
中药（TCM）被用于治疗多种疾病，包括心力衰竭（HF），尽管其特征尚不明确。
我们使用 2015 年中国西部医学医院住院心力衰竭患者随机样本中的数据，通过 China PEACE 5r-HF（中国以患者为中心的心脏事件评估 5 回顾性心力衰竭研究）进行了 TCM 使用的回顾性分析。我们使用分层逻辑回归模型描述 TCM 使用的频率及其与患者特征、院内证据治疗的使用以及医院特征之间的关系。最后，我们评估了风险调整后的院内出血和死亡率。在来自 189 家医院的 10004 名因 HF 住院的患者中（中位年龄 73 岁，48.9%为女性），74.7%的患者接受了 TCM（83.3%静脉内给药）。最常用的药物是丹参（51.2%）。患有冠状动脉疾病（比值比 [OR]，1.73；95%置信区间，1.53-1.95）或中风（OR，1.32；95%置信区间，1.15-1.51）的患者更有可能接受 TCM；与证据治疗的使用无关。几乎所有医院（99.4%）都使用了 TCM，且医院之间存在较大差异（中位数 OR，3.29；95%置信区间，2.82-3.76）。丹参会增加住院出血（OR，1.39；95%置信区间，1.03-1.88）和死亡率（OR，1.36；95%置信区间，1.04-1.79），尽管其他 TCM 则没有。
在中国接受急性 HF 住院治疗的患者中，有四分之三的患者接受了 TCM。几乎所有医院都使用了 TCM，尽管医院之间的使用情况存在很大差异。尽管 TCM 并未用于 HF 的循证治疗，但我们发现最常用的 TCM 存在危害信号。
https://www.clinicaltrials.gov。
NCT02877914。
