Chua Wei J, Liu Jing, Lam Kaitlyn, Maunder Alison, Pandey Chhiti, Cave Adele E, O'Fee Allana, Yang Guoyan, Mousa Aya, Ee Carolyn
School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia.
NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
Complement Ther Med. 2025 Aug;91:103182. doi: 10.1016/j.ctim.2025.103182. Epub 2025 Apr 24.
Heart failure (HF) is associated with multi-organ dysfunction and significant morbidity and mortality. Despite advances in treatment, prognosis remains poor, highlighting the need to explore adjunctive therapies such as integrative medicine. This umbrella review synthesises top-tier evidence from systematic reviews and meta-analyses of randomised controlled trials (RCTs) assessing the safety and effectiveness of integrative medicine in patients with HF, in order to inform clinical decision-making.
We searched MEDLINE, Cochrane, PsycINFO and EMBASE until April 2024. Primary outcomes included mortality, hospitalisation rates, and severity or prognostic indicators, including brain natriuretic peptide (BNP) and exercise capacity. A hierarchical evidence synthesis method was used whereby we included the most recent, highly ranked and comprehensive reviews for our research question. We assessed review quality using 'A MeaSurement Tool to Assess systematic Reviews' and, where possible, evidence certainty for our primary outcomes using the Grading of Recommendations Assessment, Development and Evaluation approach.
Twenty-two reviews were included. Co-enzyme Q10 or Tai Chi may reduce mortality and hospitalisation rates (moderate certainty evidence), and acupuncture or intravenous Chinese herbal medicines may improve BNP (low to very low certainty evidence). The benefits of yoga and other nutrient supplements including L-carnitine remain unclear. Vitamin E may increase hospitalisation rates and should be avoided.
The evidence for most integrative medicine modalities for adjunctive management of HF remains limited. Well-designed and rigorous RCTs are needed, particularly with long-term follow up and evaluation of clinically meaningful outcomes.
心力衰竭（HF）与多器官功能障碍以及显著的发病率和死亡率相关。尽管治疗取得了进展，但预后仍然很差，这凸显了探索辅助治疗方法（如中西医结合疗法）的必要性。本综述综合了来自系统评价和随机对照试验（RCT）的荟萃分析的顶级证据，以评估中西医结合疗法在HF患者中的安全性和有效性，为临床决策提供依据。
我们检索了MEDLINE、Cochrane、PsycINFO和EMBASE数据库，检索截至2024年4月的文献。主要结局包括死亡率、住院率以及严重程度或预后指标，包括脑钠肽（BNP）和运动能力。采用分层证据综合方法，我们纳入了针对研究问题的最新、排名靠前且全面的综述。我们使用“系统评价评估测量工具”评估综述质量，并在可能的情况下，使用推荐分级评估、制定和评价方法评估主要结局的证据确定性。
纳入了22篇综述。辅酶Q10或太极拳可能降低死亡率和住院率（中等确定性证据），针灸或静脉注射中药可能改善BNP（低至极低确定性证据）。瑜伽和其他营养补充剂（包括左旋肉碱）的益处尚不清楚。维生素E可能会增加住院率，应避免使用。
大多数中西医结合疗法用于HF辅助管理的证据仍然有限。需要设计良好且严谨的RCT，特别是进行长期随访并评估具有临床意义的结局。
