Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
Medicine (Baltimore). 2024 Aug 2;103(31):e39061. doi: 10.1097/MD.0000000000039061.
Heart failure (HF) is characterized by functional or structural dysfunction of the heart, resulting in impaired blood ejection or ventricular filling. Conventional Western Medicine (CWM) remains the mainstay of treatment for HF; however, the occurrence of adverse events (AEs) necessitates the exploration of alternative treatments. Herbal medicine and acupuncture are adjunctive therapies for HF and have shown potential for improving heart function. This systematic review and meta-analysis aimed to assess the effectiveness and safety of acupuncture and herbal medicine in treating HF.
PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by National Institute of Informatics, KoreaMed, Research Information Sharing Service, and DBpia were searched for randomized controlled trials (RCTs) evaluating the effects of acupuncture and herbal medicine along with CWM as adjunctive treatments for HF, published from inception to May 31, 2024. Treatment effectiveness was determined by evaluating the left ventricular ejection fraction as the primary metric, along with the measurement of the total effective rate, brain natriuretic peptide level, N-terminal prohormone of brain natriuretic peptide level, left ventricular end-diastolic volume, and left ventricular end-systolic volume; the administration of the Minnesota Living with Heart Failure Questionnaire; and the conduct of a 6-minute walk test. Treatment safety was evaluated based on the incidence of AEs. The methodological quality of all included RCTs was assessed using the Cochrane risk of bias tool. A meta-analysis was performed using Review Manager, version 5.4.1.
Of the 133 publications identified, 8 RCTs met the inclusion criteria. The meta-analysis showed significant improvements in left ventricular ejection fraction, brain natriuretic peptide levels, N-terminal prohormone of brain natriuretic peptide levels, left ventricular end-systolic volume, left ventricular end-diastolic volume, and 6-minute walk test results. Additionally, significant differences were observed in the total effective rate and Minnesota Living with Heart Failure Questionnaire responses. No significant medication-related AEs occurred in the intervention group. Conversely, 7 control patients developed well-known AEs associated with CWM.
Acupuncture combined with herbal medicine and CWM is more effective than CWM alone, indicating a safe treatment approach. Consequently, the proactive administration of acupuncture alongside herbal medicine to patients with HF can be undertaken without concerns regarding AEs.
心力衰竭（HF）的特征是心脏的功能或结构功能障碍，导致血液射血或心室充盈受损。传统的西方医学（CWM）仍然是 HF 的主要治疗方法；然而，不良事件（AE）的发生需要探索替代治疗方法。草药和针灸是 HF 的辅助治疗方法，并且已经显示出改善心脏功能的潜力。本系统评价和荟萃分析旨在评估针灸和草药治疗 HF 的有效性和安全性。
从建库到 2024 年 5 月 31 日，我们检索了 PubMed、Embase、Cochrane 中央对照试验注册库、中国知网、日本国立情报学研究所引文信息数据库、韩国医学文献服务与获取整合系统、韩国研究信息服务和 DBpia，以评估针灸和草药与 CWM 联合治疗 HF 的效果。治疗效果通过评估左心室射血分数作为主要指标，同时测量总有效率、脑利钠肽水平、脑利钠肽前体水平、左心室舒张末期容积和左心室收缩末期容积；进行明尼苏达州心力衰竭生活质量问卷；进行 6 分钟步行试验。根据不良事件的发生率评估治疗安全性。所有纳入的 RCT 的方法学质量使用 Cochrane 偏倚风险工具进行评估。使用 Review Manager 版本 5.4.1 进行荟萃分析。
从 133 篇出版物中，有 8 项 RCT 符合纳入标准。荟萃分析显示，左心室射血分数、脑利钠肽水平、脑利钠肽前体水平、左心室收缩末期容积、左心室舒张末期容积和 6 分钟步行试验结果均有显著改善。此外，总有效率和明尼苏达州心力衰竭生活质量问卷的反应也有显著差异。干预组未发生与药物相关的不良事件。相反，对照组有 7 名患者出现与 CWM 相关的已知不良事件。
针灸联合草药和 CWM 比 CWM 单独治疗更有效，表明这是一种安全的治疗方法。因此，可以在不担心不良事件的情况下，积极为 HF 患者提供针灸和草药治疗。
