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Traditional herbal medicine Oryeongsan for heart failure: A systematic review and meta-analysis
Da Hae Jung1, Han-Gyul Lee2, Seungwon Kwon2
1Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
Insights
Oryeongsan (ORS) combined with conventional Western medicine (CWM) significantly improves heart failure (HF) outcomes, including ejection fraction and exercise capacity. This complementary approach offers a safe and effective treatment option for HF patients, showing promise beyond CWM alone.
Area of Science:
- Cardiology
- Integrative Medicine
- Pharmacology
Background:
- Heart failure (HF) presents significant mortality and hospitalization challenges, often managed with diuretics that carry risks of electrolyte imbalance.
- Oryeongsan (ORS) and its variants are utilized in Asian countries for fluid imbalance management, including HF congestion.
- ORS is explored as a complementary therapy to mitigate diuretic limitations in HF treatment.
Purpose of the Study:
- To review the safety and effectiveness of combining Oryeongsan (ORS) with conventional Western medicine (CWM) for heart failure (HF).
Main Methods:
- A comprehensive literature search was performed across multiple databases up to July 2024.
- Fifty-nine randomized controlled trials (RCTs) involving 5069 participants were included in the meta-analysis.
- Outcomes assessed included left ventricular ejection fraction (LVEF), total effective rate (TER), functional status, and adverse events.
Main Results:
- Combining CWM with ORS significantly improved LVEF (mean difference: 6.36) and TER compared to CWM alone.
- Significant improvements were observed in LVEDD, LVESD, 6MWT, MLHF-Q, BNP, NT-proBNP, urine volume, Lee's score, and NYHA class.
- No significant difference in the incidence of adverse events was found between the treatment and control groups.
Conclusions:
- The combination of CWM with ORS or its variants demonstrates superior effectiveness in managing HF compared to CWM alone.
- This integrated approach appears to be a relatively safe treatment option for HF.
- Further research is warranted to validate these findings.
Background And Objective:
Heart failure (HF) is associated with high mortality and hospitalization rates, and its prevalence increases with age. As congestion is the most common cause of hospitalization for HF, diuretics are the most prescribed drugs. However, these agents have side effects due to electrolyte imbalance. In Asian countries, Oryeongsan (ORS) and its variants are used to manage fluid imbalances, including HF congestion. Therefore, ORS is considered a complementary treatment to overcome the limitations of diuretics. This review aimed to elucidate the safety and effectiveness of ORS combined with conventional Western medicine (CWM) for HF.
Materials And Methods:
A literature search was conducted using the PubMed, Embase, CENTRAL, Scopus, CiNii, CNKI, and ScienceON databases to retrieve relevant studies published up to July 2024. Two independent investigators were involved in the data collection and analysis. Randomized controlled trials (RCTs) that evaluated the effects of ORS and its variants in combination with CWM as treatments for HF were selected. The outcome measures included left ventricular ejection fraction (LVEF), total effective rate (TER), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), 6-min Walk Test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHF-Q), serum brain natriuretic peptide (BNP) level, serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level, 24-h urine volume, Lee's score, and New York Heart Association (NYHA) grade I ratio for effectiveness; and incidence of adverse events (AEs) for safety. The methodological quality of the included RCTs was assessed using the Cochrane's Risk of Bias tool.
Results:
Fifty-nine RCTs that comprised 5069 participants and compared CWM combined with ORS and its variants (treatment group) to CWM alone or CWM plus placebo (control group) were included. Based on the meta-analysis, LVEF was found to significantly improve (mean difference: 6.36, 95 % confidence interval: 5.11 to 7.61, P < 0.00001) in the treatment group. TER, LVEDD, LVESD, 6MWT, MLHF-Q, serum BNP and NT-proBNP levels, 24-h urine volume, Lee's score, and NYHA grade I ratio were also significantly improved in the treatment group compared with the control group with CWM alone. LVEF and TER were improved without significance in the treatment group compared with the control group with CWM plus placebo. The incidence of AEs did not significantly differ between the two groups.
Conclusions:
Combining CWM with ORS or its variants was more effective than CWM alone in managing HF and could serve as a relatively safe treatment for HF. Further studies are required to validate the findings of the present study.
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