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Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis

OBJECTIVE: Cardiac arrhythmia remains a major public health problem worldwide. Combinations of traditional medicine (TM) and conventional medicine (CM) have been used for arrhythmia treatment, yet the effectiveness and safety of many TM preparations can be controversial. We analyzed the safety and e...

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Autores principales: Yang, Yan, Ge, Fei-Lin, Huang, Qian, Zeng, Rui, Zhang, Xin-Yue, Liu, Ping, Luo, Gang, Yang, Si-Jin, Sun, Qin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904740/
https://www.ncbi.nlm.nih.gov/pubmed/35282353
http://dx.doi.org/10.3389/fcvm.2022.795903
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author Yang, Yan
Ge, Fei-Lin
Huang, Qian
Zeng, Rui
Zhang, Xin-Yue
Liu, Ping
Luo, Gang
Yang, Si-Jin
Sun, Qin
author_facet Yang, Yan
Ge, Fei-Lin
Huang, Qian
Zeng, Rui
Zhang, Xin-Yue
Liu, Ping
Luo, Gang
Yang, Si-Jin
Sun, Qin
author_sort Yang, Yan
collection PubMed
description OBJECTIVE: Cardiac arrhythmia remains a major public health problem worldwide. Combinations of traditional medicine (TM) and conventional medicine (CM) have been used for arrhythmia treatment, yet the effectiveness and safety of many TM preparations can be controversial. We analyzed the safety and effectiveness of Zhigancao decoction (ZGCD) combined with metoprolol for arrhythmia treatment. METHODS: Systematic searches for randomized clinical trials (RCTs) were conducted in eight databases (January 2010–September 2020) without language restrictions. According to the Cochrane system evaluation method, the overall effectiveness and safety were evaluated by meta-analysis using Review Manager software (version 5.3), and publication bias was qualitatively analyzed using STATA 12.0. RESULTS: A total of 39 RCTs were incorporated, including 4,260 patients with arrhythmia, with 2,133 patients in the experimental group (ZGCD + metoprolol, ZGCD + BB) and 2,127 patients in the control group (metoprolol only, BB). Meta-analysis revealed that compared with BB, ZGCD + BB could significantly increase the total efficacy (OR = 4.74, 95% CI: 3.78–5.94, P < 0.01) and lower the incidences of arrhythmia (MD = −3.39, 95% CI: −4.09 to −2.68, P < 0.01). Moreover, mean HR reductions were reported in patients receiving ZGCD + BB the ZGCD + BB group (MD = −8.48, 95% CI: −10.98 to −5.97, P < 0.01) and a decrease in TCM symptoms were reported also (MD = −2.92, 95% CI: −3.08 to −2.76, P < 0.01). The incidence of adverse events was lower in patients treated with ZGCD + BB (RR = 0.36, 95% CI: 0.26–0.51, P < 0.01). These results appeared consistent across common arrhythmias. Nevertheless, the majority of included studies were unable to be formally assessed for bias, and funnel-plot analysis implied a moderate risk of publication bias. CONCLUSION: ZGCD + BB appeared to demonstrate good efficacy and fewer adverse reactions compared to BB in the treatment of arrhythmia, and this may represent a useful complementary therapy. However, our findings must be cautiously evaluated because of the small sample size and low quality of the clinic trials cited in the review. Rigorous and large-scale RCTs are warranted in the future to confirm these results. SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2021-10-0045/.
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spelling pubmed-89047402022-03-10 Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis Yang, Yan Ge, Fei-Lin Huang, Qian Zeng, Rui Zhang, Xin-Yue Liu, Ping Luo, Gang Yang, Si-Jin Sun, Qin Front Cardiovasc Med Cardiovascular Medicine OBJECTIVE: Cardiac arrhythmia remains a major public health problem worldwide. Combinations of traditional medicine (TM) and conventional medicine (CM) have been used for arrhythmia treatment, yet the effectiveness and safety of many TM preparations can be controversial. We analyzed the safety and effectiveness of Zhigancao decoction (ZGCD) combined with metoprolol for arrhythmia treatment. METHODS: Systematic searches for randomized clinical trials (RCTs) were conducted in eight databases (January 2010–September 2020) without language restrictions. According to the Cochrane system evaluation method, the overall effectiveness and safety were evaluated by meta-analysis using Review Manager software (version 5.3), and publication bias was qualitatively analyzed using STATA 12.0. RESULTS: A total of 39 RCTs were incorporated, including 4,260 patients with arrhythmia, with 2,133 patients in the experimental group (ZGCD + metoprolol, ZGCD + BB) and 2,127 patients in the control group (metoprolol only, BB). Meta-analysis revealed that compared with BB, ZGCD + BB could significantly increase the total efficacy (OR = 4.74, 95% CI: 3.78–5.94, P < 0.01) and lower the incidences of arrhythmia (MD = −3.39, 95% CI: −4.09 to −2.68, P < 0.01). Moreover, mean HR reductions were reported in patients receiving ZGCD + BB the ZGCD + BB group (MD = −8.48, 95% CI: −10.98 to −5.97, P < 0.01) and a decrease in TCM symptoms were reported also (MD = −2.92, 95% CI: −3.08 to −2.76, P < 0.01). The incidence of adverse events was lower in patients treated with ZGCD + BB (RR = 0.36, 95% CI: 0.26–0.51, P < 0.01). These results appeared consistent across common arrhythmias. Nevertheless, the majority of included studies were unable to be formally assessed for bias, and funnel-plot analysis implied a moderate risk of publication bias. CONCLUSION: ZGCD + BB appeared to demonstrate good efficacy and fewer adverse reactions compared to BB in the treatment of arrhythmia, and this may represent a useful complementary therapy. However, our findings must be cautiously evaluated because of the small sample size and low quality of the clinic trials cited in the review. Rigorous and large-scale RCTs are warranted in the future to confirm these results. SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2021-10-0045/. Frontiers Media S.A. 2022-02-23 /pmc/articles/PMC8904740/ /pubmed/35282353 http://dx.doi.org/10.3389/fcvm.2022.795903 Text en Copyright © 2022 Yang, Ge, Huang, Zeng, Zhang, Liu, Luo, Yang and Sun. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Yang, Yan
Ge, Fei-Lin
Huang, Qian
Zeng, Rui
Zhang, Xin-Yue
Liu, Ping
Luo, Gang
Yang, Si-Jin
Sun, Qin
Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title_full Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title_fullStr Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title_full_unstemmed Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title_short Randomized Controlled Trials of Zhigancao Decoction Combined With Metoprolol in the Treatment of Arrhythmia: A Systematic Review and Meta-Analysis
title_sort randomized controlled trials of zhigancao decoction combined with metoprolol in the treatment of arrhythmia: a systematic review and meta-analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904740/
https://www.ncbi.nlm.nih.gov/pubmed/35282353
http://dx.doi.org/10.3389/fcvm.2022.795903
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