title: Clinical effects of a standardized Chinese herbal remedy, Qili Qiangxin, as an adjuvant treatment in heart failure: systematic review and meta-analysis.
abstract: BACKGROUND
  Qili Qiangxin capsule is a standardized Chinese herbal treatment that is commonly used in China for heart failure (HF) alongside conventional medical care. In 2014, Chinese guidelines for the treatment of chronic HF highlighted Qili Qiangxin capsules as a potentially effective medicine. However, there is at present no high quality review to evaluate the effects and safety of Qili Qiangxin for patients with HF.
  
  
  METHODS
  We conducted a systematic review and meta-analysis and followed methods described in our registered protocol [PROSPERO registration: CRD42013006106]. We searched 6 electronic databases to identify randomized clinical trials (RCTs) irrespective of blinding or placebo control of Qili Qiangxin used as an adjuvant treatment for HF.
  
  
  RESULTS
  We included a total of 129 RCTs published between 2005 and 2015, involving 11,547 patients, aged 18 to 98 years. Meta-analysis showed no significant difference between Qili Qiangxin plus conventional treatment and conventional treatment alone for mortality (RR 0.53, 95 % CI 0.27 to 1.07). However, compared with conventional treatment alone, Qili Qiangxin plus conventional treatment demonstrated a significant reduction in major cardiovascular events (RR 0.46, 95 % CI 0.34 to 0.64) and a significant reduction in re-hospitalization rate due to HF (RR 0.49, 95 % CI 0.38 to 0.64). Qili Qiangxin also showed significant improvement in cardiac function measured by the New York Heart Association scale (RR 1.38, 95 % CI 1.29 to 1.48) and quality of life as measured by Minnesota Living with Heart Failure Questionnaire (MD -8.48 scores, 95 % CI -9.56 to -7.39). There were no reports of serious adverse events relating to Qili Qiangxin administration. The majority of included trials were of poor methodological quality.
  
  
  CONCLUSIONS
  When compared with conventional treatment alone, Qili Qiangxin combined with conventional treatment demonstrated a significant effect in reducing cardiovascular events and re-hospitalization rate, though not in mortality. It appeared to significantly improve quality of life in patients with HF and data from RCTs suggested that Qili Qiangxin is likely safe. This data was drawn from low quality trials and the results of this review must therefore be interpreted with caution. Further research is warranted, ideally involving large, prospective, rigorous trials, in order to confirm these findings.
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Sun
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Wen-Jing
authors.initials: WJ
authors.lastname: Xiong
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Guo-Yan
authors.initials: GY
authors.lastname: Yang
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Yun-Jiao
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Cong-Cong
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Complementary and Integrated Medicine Research Unit, Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Lily
authors.initials: L
authors.lastname: Lai
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Han
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ren
authors.affiliation: Complementary and Integrated Medicine Research Unit, Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.affiliation: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China. jianping_l@hotmail.com.|National Research Centre in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. jianping_l@hotmail.com.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; C572413:qiliqiangxin
keywords: Chinese herbal medicine; Heart failure; Meta-analysis; Qili Qiangxin capsule; Randomized clinical trials; Systematic review