The efficacy and safety of Wulingsan modified formulas for chronic heart failure patients: a systematic review and meta-analysis

BACKGROUND: Chronic heart failure (CHF) is one of the most common cardiovascular diseases, which has caused huge economic burden worldwide. Wulingsan modified formulas have been historically used for CHF in China. However, the efficacy of its treatment for CHF has not been summarized by scholars and lacks of clinical evidence. This study aimed to assess the efficacy and safety of Wulingsan modified formulas for patients with CHF. METHODS: A comprehensive literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, Medline (Ovid), China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and SinoMed databases from the date of their inception up to 1(st) November, 2021. Only randomized controlled trials evaluating Wulingsan modified formulas in patients with CHF were included. The primary outcome of this study was efficacy of Wulingsan modified formulas in the treatment of CHF, and the secondary outcomes included brain natriuretic peptide, left ventricular ejection fractions, and any other changes in the patients’ condition. The risk ratio was applied to evaluate efficiency, and the weighted mean difference (WMD) and 95% confidence interval (CI) were used to merge the continuous variables. The I(2) statistic was used to assess the heterogeneity. Sensitivity analysis was used to evaluate whether the single research affected the whole results. Data were extracted by two independent investigators. The Cochrane Risk of Bias tool (version 2.0) was utilized to evaluate the included studies, STATA (version 15.0) was applied for sensitivity analysis, and RevMan 5.3 software was used to conduct the systematic review and meta-analysis. RESULTS: Nineteen studies with a total of 1,631 were included in this meta-analysis. The meta-analysis results were as follows: efficiency, the risk ratio =1.21, 95% CI: 1.15, 1.27; brain natriuretic peptide, WMD =−269.14, 95% CI: −349.25, −189.04; and left ventricular ejection fractions, WMD =8.80, 95% CI: 5.93, 11.68. All of these findings were statistically significant. No statistically significant adverse events were reported in the included articles. DISCUSSION: Wulingsan modified formulas are a reasonable and relatively safe adjuvant therapy for the treatment of CHF.