Shexiang Baoxin Pills as an Adjuvant Treatment for Chronic Heart Failure: A System Review and Meta-Analysis

BACKGROUND: Shexiang Baoxin pills (SXBXP), as a Traditional Chinese Medicine, are widely used for chronic heart failure in China. It is essential to systematically assess the efficacy and safety of SXBXP as an adjuvant treatment for chronic heart failure. METHODS: Seven English and Chinese electronic databases (PubMed, Embase, Cochrane Library, CBM, Wanfang, VMIS, and CNKI) were searched from inception to July 2017. The Cochrane Risk of Bias tool was used to evaluate the methodological quality of eligible studies. Meta-analysis was performed by Review Manager 5.3. RESULTS: A total of 27 RCTs with 2637 participants were included in this review. Compared to conventional treatment, SXBXP combined with conventional treatment showed potent efficacy when it came to the total efficacy rate (OR, 3.88; 95% CI, 2.87, 5.26; P < 0.00001), B-type natriuretic peptide (BNP) (MD = −66.95; 95% CI, −108.57, −25.34; P = 0.002), N-terminal pro-brain natriuretic peptide (NT-ProBNP) (MD = −0.15; 95% CI, −0.21, −0.09; P < 0.00001), six-minute walking distance (6-MWD) (MD = 38.57; 95% CI, 28.47, 48.67; P < 0.00001), cardiac output (CO) (MD = 0.84; 95% CI, 0.68, 0.99; P < 0.00001), and Stroke Volume (SV) (MD = 7.43; 95% CI, 4.42, 10.44, P < 0.00001). The pooled subgroup analysis indicated that there was a significant difference between SXBXP plus conventional treatment and conventional treatment alone in short term course (OR = 3.51; 95% CI, 2.28, 5.40; P < 0.00001), in middle period of treatment (OR = 5.01; 95% CI, 2.61, 9.60; P < 0.00001), and in long-term course (OR = 3.77; 95% CI, 2.13, 6.67; P < 0.00001). No serious adverse events or reactions were mentioned in these RCTs. CONCLUSIONS: As an adjuvant drug, this study suggested that SXBXP provide an obvious efficacy for the treatment of CHF. However, due to small samples and generally low quality studies being applied in this study, more rigorous and well-designed RCTs are needed to confirm these findings.