Traditional Chinese medicine reduces hospitalization, cardiovascular deaths among heart failure patients

AMSTERDAM, Netherlands — Millions worldwide turn to traditional Chinese medicine for things like acupuncture, herbal remedies, and therapeutic massages. Now, a recent study reveals that a specific treatment from traditional Chinese medicine can significantly reduce hospitalization rates and cardiovascular death in heart failure patients.

Qiliqiangxin is an extract derived from 11 types of herbs. In earlier research, it was found that qiliqiangxin reduced levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and improved heart failure symptoms when added to standard heart failure treatments. Preclinical studies have also shown its potential to attenuate myocardial fibrosis and cardiac remodeling.

The QUEST trial aimed to assess the clinical effectiveness and safety of qiliqiangxin on major heart failure outcomes in heart failure in reduced ejection fraction (HFrEF) patients. It was conducted at 133 hospitals in mainland China and Hong Kong SAR of China.

The trial involved adult HFrEF patients with a left ventricular ejection fraction of 40 percent or lower and NT-proBNP levels of 450 pg/ml or higher, who had been on a stable, standardized baseline treatment for at least two weeks before enrollment. Patients were randomly assigned to take either qiliqiangxin (four capsules, three times daily) or a placebo in addition to their regular medications for chronic heart failure. The primary endpoint was a combination of rehospitalization for worsening heart failure or cardiovascular death.

Researchers analyzed a total of 3,110 patients, with half receiving qiliqiangxin and the other half receiving a placebo. The average age of participants was 62, and 72.1 percent were men. At the beginning of the study, the mean left ventricular ejection fraction was 32 percent, and the median NT-proBNP was 1730.80 pg/ml.

Over an average follow-up period of 18.3 months, the primary endpoint occurred in over 25 percent of the qiliqiangxin group compared to 30 percent in the placebo group. This resulted in a significant reduction in the risk of the primary endpoint for the qiliqiangxin group. This reduction was attributed to both a lower risk of rehospitalization for worsening heart failure and cardiovascular death in the qiliqiangxin group. The effect was consistent across various subgroups, including age and NT-proBNP levels, and among patients with or without angiotensin receptor/neprilysin inhibitors (ARNIs).

Regarding secondary endpoints, the qiliqiangxin group showed a greater reduction in serum NT-proBNP levels between baseline and the three-month follow-up compared to the placebo group. This aligned with the findings of a previous pilot study.

The analysis of safety endpoints revealed no significant difference in all-cause mortality between the two groups. Qiliqiangxin capsules were well-tolerated, with no major differences in adverse events, including gastrointestinal symptoms, worsening renal function, and increased liver enzymes.

“To our knowledge, this was the first randomized, double-blind controlled trial of a traditional Chinese medicine for the treatment of chronic heart failure,” says study principal investigator Xinli Li, professor at the First Affiliated Hospital of Nanjing Medical University, in a media release. “Our findings demonstrate meaningful clinical benefit with qiliqiangxin in patients with HFrEF, which support the use of qiliqiangxin as an adjunct therapy for treating heart failure.”

The research was presented at the European Society of Cardiology Congress 2023 in Amsterdam.

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