Efficacy and safety of Yangxinshi tablet for chronic heart failure: A systematic review and meta-analysis

Table 1 Basic characteristics of included studies

Ref.	Sample size	Male (%)	Age (yr)	Disease duration (yr)	Intervention	Treatment duration (wk)	Left ventricular function	Type of CHF	Baseline cardiac disease
Bai and Li[19], 2023	44	54.5	62.8 ± 5.3	10.6 ± 2.2	Perindopril, metoprolol, trimetazidine, and YXST (0.18 g tid)	4			ICM
	44	52.3	62.0 ± 5.1	10.8 ± 2.4	Perindopril, metoprolol, and trimetazidine	4
Bai[20], 2019	50	50.0	66.6 ± 10.4		Telmisartan, amlodipine, and YXST (0.18 g tid)	4			ICM
	50	52.0	66.5 ± 10.2		Telmisartan and amlodipine	4
Cheng et al[21], 2019	48	54.2	71.2 ± 3.6		Levocarnitine and YXST (0.18 g tid)	1	Left ventricular diastolic dysfunction	HFpEF
	48	52.1	71.9 ± 3.8		Levocarnitine	1
Chen[22], 2019	20	70.0	64.0 ± 11.0		ACEI/ARB, MRA, diuretic, cardiotonic, and YXST (0.18 g tid)	4
	20	85.0	63.0 ± 10.0		ACEI/ARB, MRA, diuretic, and cardiotonic	4
Fan et al[23], 2020	63	52.4	66.0 ± 3.7		Optimizing drug therapy and YXST (0.18 g tid)	48
	63	57.1	67.0 ± 3.6		Optimizing drug therapy	48
Fu et al[26], 2014	64	65.6	65.0 ± 10.2	2.4 ± 1.2	ACEI, diuretic, cardiotonic, and YXST (0.18 g tid)	12			NICM
	62	64.5	64.0 ± 10.8	2.3 ± 1.4	ACEI, diuretic, and cardiotonic	12
Gu et al[25], 2016	60	65.0	61.8 ± 11.8		Perindopril, metoprolol, spironolactone, furosemide, isosorbide mononitrate, aspirin, clopidogrel, atorvastatin, and YXST (0.18 g tid)	24
	60	70.0	62.5 ± 15.3		Perindopril, metoprolol, spironolactone, furosemide, isosorbide mononitrate, aspirin, clopidogrel, and atorvastatin	24
Gao and Zhang[24], 2021	39	51.3	62.54 ± 7.5		Benazepril, metoprolol, furosemide, digoxin, and YXST (0.18 g tid)	24
	39	53.8	63.0 ± 6.8		Benazepril, metoprolol, furosemide, and digoxin	24
Huang et al[27], 2009	63	58.7	59.8 ± 11.2	5.2 ± 4.3	ACEI, β-blocker, diuretic, vasodilator, and YXST (0.18 g tid)	4	Left ventricular diastolic dysfunction	HFmrEF, HFpEF
	62	58.1	61.2 ± 13.4	5.0 ± 4.9	ACEI, β-blocker, diuretic, and vasodilator	4
Li and Zhou[28], 2019	60	56.7	66.6 ± 12.5	5.7 ± 2.1	Bisoprolol and YXST (0.12 g tid)	24			ICM
	60	43.3	64.9 ± 12.3	5.7 ± 2.0	Bisoprolol	24
Li[29], 2017	47	53.2	61.35 ± 8.7	9.3 ± 3.6	Diuretic, vasodilator, trimetazidine, statin, and YXST (0.18 g tid)	4			ICM
	47	51.2	61.58 ± 7.6	9.52 ± 2.9	Diuretic, vasodilator, trimetazidine, and statin	4
Liu[30], 2022	33	48.5	58.4 ± 11.5	9.5 ± 3.1	ACEI/ARB, β-blocker, MRA, diuretic, and YXST (0.18 g tid)	12	Left ventricular diastolic dysfunction	HFpEF
	32	43.8	57.1 ± 12.8	10.2 ± 3.7	ACEI/ARB, β-blocker, MRA, and diuretic	12
Qian and Wei[31], 2012	56				ACEI, β-blocker, diuretic, vasodilator, cardiotonic, and YXST (0.12g tid)	12			NICM
	56				ACEI, β-blocker, diuretic, vasodilator, and vardiotonic	12
Qu[32], 2008	89	61.8	52.0 ± 13.1		ACEI, β-blocker, diuretic, vasodilator, cardiotonic, and YXST (0.18g tid)	24
	82	62.2	53.3 ± 18.3		ACEI, β-blocker, diuretic, vasodilator, and cardiotonic	24
Sun et al[35], 2016	34	44.1	58.0 ± 13.1		ACEI, β-blocker, diuretic, and YXST (0.18g tid)	16
	34	52.9	54.3 ± 15.3		ACEI, β-blocker, and diuretic	16
Wang et al[33], 2011	34	64.7			Spironolactone, hydrochlorothiazide, nitroglycerin, dobutamine, and YXST (0.24 g tid)	2
	26	69.2			Spironolactone, hydrochlorothiazide, nitroglycerin, and dobutamine	2
Yuan[34], 2012	40	52.5	68.7 ± 10.2	3.2 ± 0.7	ACEI, β-blocker, diuretic, vasodilator, and YXST (0.24 g tid)	4	Left ventricular diastolic dysfunction	HFpEF
	35	51.4	71.3 ± 13.1	2.9 ± 0.9	ACEI, β-blocker, diuretic, and vasodilator	4
Zhang and Niu[36], 2017	34	52.9	55.7 ± 9.6	6.0 ± 3.3	Benazepril, metoprolol, losartan potassium, hydrochlorothiazide, and YXST (0.18 g tid)	8	Left ventricular diastolic dysfunction	HFmrEF, HFpEF
	33	63.6	54.1 ± 9.6	6.1 ± 3.2	Benazepril, metoprolol, losartan potassium, and hydrochlorothiazide	8
Zhang[37], 2018	30	60.0	63.8 ± 4.8		ACEI, β-blocker, MRA, and YXST (0.18 g tid)	12
	30	56.7	62.6 ± 5.2		ACEI, β-blocker and MRA	12
Zhang[38], 2022	27	48.1	65.2 ± 5.3	5.2 ± 1.0	ARNI/ARB, β-blocker, MRA, diuretic, vasodilator, cardiotonic, and YXST (0.18 g tid)	8		HFrEF
	27	58.6	64.1 ± 6.0	5.1 ± 1.2	ARNI/ARB, β-blocker, MRA, diuretic, vasodilator, and cardiotonic	8

ACEI: Angiotensin converting enzyme inhibitor; ARB: Angiotensin receptor blocker; ARNI: Angiotensin receptor II blocker neprilysin inhibitor; MRA: Mineralcorticoid receptor antagonist; YXST: Yangxinshi tablet; CHF: Chronic heart failure; HFpEF: Heart failure with preserved ejection fraction; HFmrEF: Heart failure with mid-range ejection fraction; HFrEF: Heart failure with reduced ejection fraction; ICM: Ischemic cardiomyopathy; NICM: Non-ischemic cardiomyopathy.

Table 2 Meta-analysis results for efficacy endpoints of Yangxinshi tablet in treating heart failure with preserved ejection fraction

Outcome	Sample size (E/C)	I2/%	MD/RR (95%CI)	P value
Clinical efficacy rate	88/83	37	1.19 (1.06-1.33)	0.003
NT-proBNP	48/48	0	-0.73 (-0.95 to -0.51)	< 0.00001
6-MWT	121/115	80	44.61 (17.58-71.65)	0.001

E: Experiment group; C: Control group; NT-proBNP: N-terminal pro-B-type natriuretic peptide; 6-MWT: 6-min walk test; MD: Mean difference; RR: Relative risk; I²: I-squared statistic.