Effect of Integrative Chinese and Western Medicine Therapy on Long-Term Clinical Outcomes in Patients with Heart Failure: A Real-World Study Including 394 Patients

Abstract

Objective. To explore the effect of integrative Chinese and Western medicine therapy on the clinical outcomes of patients with heart failure. Methods. This is a retrospective cohort study in the real world. Patients were divided into “conventional therapy” and “integrative therapy” groups according to treatment modality. The occurrence of cardiovascular events (CVE) was determined during follow-up. Survival curves were plotted, and survival analysis was performed using Cox regression to report survival in both groups. Further subgroup tests were performed as sensitivity analyses. A Markov model was constructed to predict patients with distant heart failure conditions based on real follow-up data. Results. Based on diagnostic criteria, 394 patients with heart failure were included. The integrative therapy group had (N = 181) older patients ( $P=0.005$ ), higher proportion of renal insufficiency ( $P<0.001$ ), higher creatinine ( $P=0.040$ ), hypersensitive C-reactive protein ( $P=0.007$ ), N-terminal pro-B type natriuretic peptide ( $P=0.019$ ) levels, more patients in cardiac function class IV ( $P=0.004$ ), and longer hospital days ( $P=0.003$ ) than the conventional therapy group (N = 213). Survival was better in the integrative therapy group than in the conventional therapy group (log-rank $P<0.001$ ). Multifactorial Cox regression identified “conventional therapy” or “integrative therapy” as an independent factor affecting the risk of CVE in patients with heart failure, with the risk of CVE being lower in the integrative therapy group (HR = 0.322, 95% CI = 0.185–0.561). A subgroup analysis found no significant association between therapy modality and risk of CVE in older patients (age ≥65 years, $P=0.210$ ) and those who had renal insufficiency ( $P=0.062$ ). The Markov model predicted better cardiac function in the integrative therapy group than in the conventional therapy group at all time points (all $P<0.001$ ). Conclusion. In patients with heart failure, integrative therapy of Chinese and Western medicine had better long-term outcomes than conventional therapy. However, patients with advanced age and renal insufficiency had no significant advantage. Trials Registration. This trial is registered with China Clinical Trials Registry, ChiCTR2100050927, registered 8 September 2021, https://www.chictr.org.cn/showproj.aspx?proj=133451.