The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A Systematic Review and Meta-Analysis

BACKGROUND: Acupuncture and moxibustion (A&M) has been used for treating heart failure in China since the Han Dynasty. This ancient therapy can be applied to many diseases according to the WHO recommendations. Although there are many clinical reports on the treatment of heart failure by A&M, its effectiveness is still not fully demonstrated. We aimed to systematically review the related randomized controlled trial (RCT) studies and conduct a meta-analysis. METHODS: The PubMed, MEDLINE, EMBASE, AMED, CENTRAL, CNKI, Wanfang, and Weipu databases were searched electronically until December 2018. The data were extracted, and the risk of bias was evaluated. Meta-analysis, subgroup analysis, and metaregression were performed. Heart function was the main outcome assessed. The details of the intervention were also investigated. RESULTS: Thirty-two RCTs involving 2499 patients were included. Most studies had an unclear risk regarding blinding and allocation concealment. Compared with the traditional treatment group, the experimental group had a higher efficacy rate (odds ratio (OR) = 2.61, 95% confidence interval (95%CI): = [1.84; 3.72], I(2) = 0%, p < 0.0001) and a significantly improved left ventricular ejection fraction (LVEF) (mean difference (MD) = 6.34, 95%CI = [4.11, 8.57], I(2) = 93%, p < 0.0001), cardiac output (CO) (MD = 1.02, 95%CI = [0.65, 1.39], I(2) = 94%, p < 0.0001), 6-minute walk test (6MWT) (MD = 43.6, 95%CI = [37.43, 49.77], I(2) = 0%, p < 0.0001), and reduced brain-type natriuretic peptide (BNP) (MD = −227.99, 95%CI = [−337.30, −118.68], I(2) = 96%, p < 0.0001). Adverse events were inadequately reported in most studies. CONCLUSIONS: A&M may be a promising intervention as an adjunctive therapy to medication for treating heart failure. However, the evidence was inconclusive. Further large and rigorously designed RCTs are needed for verification.