Heart Failure/drug therapy* ; Humans

Chronic Disease ; Heart Failure ; drug therapy ; Humans

BACKGROUND: Chronic heart failure (HF) disease as an emerging epidemic has a high economic burden, hospitalization, readmission, morbidity rates despite many clinical practice guidelines recommendations.

OBJECTIVE: To show that the attributed survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' Class I-A recommendations as "initial HF drug therapy" is basically "add-on HF drug therapy" to the "baseline HF drug therapy" thereby under-estimating the "baseline HF drug therapy" significant contribution to the clinical outcome.

METHODOLOGY: The references cited in the chronic HF clinical practice guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), the Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.

RESULTS: The "baseline HF drug therapy" using glycosides and diuretics is 79-100% in the cited HF trials. The survival and hospitalization event-free rates attributed to the "baseline HF drug therapy" are 46-89% and 61.8-90%, respectively. The survival and hospitalization-free event rate of the "initial HF drug therapy" is 61-92.8% and 61.8-90%, respectively. Thus the survival and hospitalization event-free rates of the "add-on HF drug therapy" are 0.4-15% and 4.6% to 14.7%, respectively. The extrapolated "baseline HF drug therapy" survival is 8-51% based on a 38% natural HF survival rate for the time period.

CONCLUSION: The contribution of "baseline HF drug therapy" is relevant in terms of survival and hospitalization event-free rates compared to the HF Class 1-A guidelines proposed "initial HF drug therapy" which is in essence an "add-on HF drug therapy" in this analysis.

The prevalence of heart failure (HF) has been steadily increasing and it now creates an enormous social and economic burden. HF is a syndrome characterized by a high mortality rate, frequent hospitalization, a reduced quality of life, and a complex therapeutic regimen. In the last three decades, major progress in both the diagnosis and management of HF has taken place, and the pharmacologic and non-pharmacologic advances have led to a significant improvement in survival and symptoms in HF patients. After an accurate diagnosis, a proper HF management plan requires a multi-level team approach comprised of the correct combination of drug therapy, device therapy, and surgery, including heart transplantation. In this review, we focused on the pharmacologic and non-pharmacologic treatment strategies for HF with reduced ejection fraction. The goal was to develop treatment guidelines based on significant evidence derived from large clinical trials.
Diagnosis ; Drug Therapy ; Heart Failure* ; Heart Failure, Systolic ; Heart Transplantation ; Hospitalization ; Humans ; Mortality ; Prevalence ; Quality of Life

Antidiuretic Hormone Receptor Antagonists ; Heart Failure ; drug therapy ; Humans

Humans ; Iron/therapeutic use* ; Heart Failure/drug therapy* ; Dietary Supplements

Heart ; drug effects ; Heart Failure ; drug therapy ; Humans ; Hydrogen Bonding ; Nitrogen Oxides ; pharmacology ; therapeutic use

To systematically evaluate the clinical efficacy and safety of Xinmailong Injection in the treatment of heart failure after acute myocardial infarction. Seven Chinese and English databases, namely CNKI, VIP, Wanfang, SinoMed and PubMed, EMbase, Cochrane Library, were retrieved from the establishment of the database to March 2020. Randomized controlled trials for Xinmailong Injection in the treatment of heart failure after acute myocardial infarction were screened out. Cochrane collaboration network bias risk assessment tool was used to evaluate the literature quality of the studies included, and RevMan 5.3 software was used for Meta-analysis. A total of 926 relevant literatures were retrieved, and 12 studies were finally included, involving 972 patients, including 486 patients in the treatment group and 486 patients in the control group. The quality of the literatures included was generally low. The results of Meta-analysis showed that Xinmailong Injection combined with Western medicine could decrease the levels of BNP(SMD=-5.90, 95%CI[-8.45,-3.36], P<0.000 01) and NT-proBNP(SMD=-2.28, 95%CI[-3.13,-1.43], P<0.000 01) and decrease the levels of cTnI(SMD=-2.91, 95%CI[-4.21,-1.60], P<0.000 1), increase LVEF(MD=4.67, 95%CI[4.19, 5.16], P<0.000 01), increased 6 MWT(MD=73.90, 95%CI[67.51, 80.28], P<0.000 01], decreased LVEDD(MD=-5.46, 95%CI[-9.66,-1.25], P=0.01), reduce the level of serum inflammatory factor(hs-CRP, CRP, IL-6). In terms of safety, less adverse reactions occurred in the study, with no impact on the treatment. The results showed that clinical use of Xinmailong Injection combined with Western medicine in the treatment of heart failure after acute myocardial infarction can further alleviate clinical symptoms and relevant indexes, with less adverse reactions. However, due to the limitations in quantity and quality of the clinical studies included, the positive results can only be used as a hint and reference for clinical diagnosis and treatment, and more high-quality studies are needed to further confirm its efficacy.
Drugs, Chinese Herbal/therapeutic use* ; Heart Failure/drug therapy* ; Humans ; Injections ; Myocardial Infarction/drug therapy*

Mufangji Decoction is a famous herbal formula from Synopsis of Golden Chamber. However,it is easy to be misunderstood due to so its unique compatability. The syndromes treated by Mufangji Decoction included the following aspects:(1) in terms of modern medicine,it could be used to treat acute and chronic heart failure,heart failure aggravated by lung infection,chronic obstructive pulmonary disease acute episode,pulmonary heart disease,bilateral pleural effusion,acute attack of gout,rheumatic fever,rheumatoid arthritis,and rheumatoid arthritis;(2) in terms of symptoms,it could be used to treat asthma,chest tightness,wheeze impacting prostration and dyspnea impacting sitting posture; gastric distention; dark face,cyanotic,and mitral valvular face; edema of head and extremities; dry mouth,thirsty,unwilling to wear thick clothes,intolerance of heat,and irritable; fatigue,shortness of breath,poor appetite,constipation,less urine,yellow color,poor response to diuretics,and diuretic resistance; fast heart rate,which is hard to be controlled by Western medicine and has no response to Zhenwu Decoction; dark red tongue,dry tongue with yellow fur,rapid pulse,or deep tight pulse. In emergency and severe cases,Yang deficiency and fluid retention are normal syndromes of heart failure,while Yang deficiency,fluid retention,and heat are metamorphic syndromes of heart failure,which possessed complex mechanisms of pathophysiology; the mechanisms of Shaoyin heat-conversion syndrome is similar to Yang deficiency,fluid retention,and heat syndrome; the reason of application of gypsum in Mufangji Decoction shall be further studied; the " empty" and " real" in modified Mufangji Decoction are physical signs,rather than pathogenesis.
Drugs, Chinese Herbal ; therapeutic use ; Heart Failure ; drug therapy ; Humans ; Yang Deficiency ; drug therapy

Humans ; Heart Failure/drug therapy* ; Diabetes Mellitus, Type 2/drug therapy* ; Glucose ; Sodium