Efficacy and safety of Guipi Decoction in the treatment of chronic heart failure: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Chronic heart failure (CHF) is the ultimate destination of most cardiovascular diseases and one of the leading causes of death for the elderly. Despite significant advances in the therapy of heart failure, the mortality and rehospitalization rates remain high. Guipi Decoction (GPD) has been reported to be significantly effective on patients with CHF, but it still lacks evidence-based medicine support. Methods: Two investigators systematically searched a total of 8 databases including PubMed, Embase, The Cochrane Library, Web of Science, Wanfang, China National Knowledge Infrastructure (CNKI), VIP, and CBM from construction to Nov 2022. Randomized controlled trials that compared GPD or in combination with conventional western medicine versus western medicine alone in the treatment of CHF were eligible for selection. The quality of included studies were evaluated and assigned data were extracted according to the method provided by Cochrane. All analyses used Review Manager 5.3 software. Results: The search identified 17 studies with a sample size of 1806 patients. Meta-analysis showed that GPD intervention was associated with an improvement in total clinical effective rate with a relative risk of 1.19 (95% confidence interval [CI] [1.15, 1.24]), P < .00001]. In terms of cardiac function and ventricular remodeling, GPT could improve left ventricular ejection fraction (mean difference [MD] = 6.41, 95% CI [4.32, 8.50], P < .00001), reduce left ventricular end diastolic diameter (MD = −6.22, 95% CI [−7.17, −5.28], P < .00001) and left ventricular end systolic diameter (MD = −4.92, 95% CI [−5.93, −3.90], P < .00001). In terms of hematological indices, GPD could decrease the levels of N-terminal pro-brain natriuretic peptide (standardized MD = −2.31, 95% CI [−3.05, −1.58], P < .00001) and C-reactive protein (MD = −3.51, 95% CI [−4.10, −2.92], P < .00001). And the analysis of safety revealed no significant differences in adverse effects between the 2 groups with a relative risk of 0.56 (95% CI [0.20, 0.89], P = .55). Conclusion: GPD can improve cardiac function and inhibit ventricular remodeling with few adverse effects. However, more rigorous and high-quality randomized controlled trials are needed to verify the conclusion.