Secondly, limited outcomes were reported, especially death and adverse events. Since HF is a disease with high mortality, death is the most important primary outcome. However, only eleven studies out of ninety seven trials reported death, and most of the eleven trials assessed mortality at the end of treatment, without followup. Another outcome was adverse events, to which more attention should be attached. Only 37.4% of the trials described the occurrence of adverse events, indicating an incomplete evaluation of the safety profile of SFI, as well as poor quality of reporting. In most trials, the duration of therapy and followup was 22 Evidence-Based Complementary and Alternative Medicine too short to achieve conclusive results, except that only one trial had a treatment of 10 months [47] . Only 6 included trials had a followup period (ranged from 3 to 12 months), while in rest of studies, the outcomes were evaluated at the end of the treatment (mostly range from 14 to 21 days). In order to evaluate drug efficacy for chronic HF, long-term improvement (at least 6 months) of chronic HF-specific clinical symptoms is needed [114] , because some drugs have shown to increase mortality in the long-term application despite a short-term improvement in clinical symptoms [115] . In addition, long-term toxicity assessment was also important for drug safety evaluation.