Query: Chronic heart failure in China

title: A multi center, randomized, double blind, placebo parallel controlled trial for the efficacy and safety of shenfuqiangxin pills in the treatment of chronic heart failure (Heart Kidney yang deficiency syndrome)
abstract: Heart failure (HF) is the final stage of various cardiac diseases with poor prognosis. The integrated traditional Chinese medicine (TCM) and western medicine therapy has been considered as a prospective therapeutic strategy for chronic heart failure (CHF) There have been small clinical trials and experimental studies to demonstrate the efficacy of Shenfu Qiangxin Pills (SFQX) for treating CHF, however, there is still a lack of further high quality trial. This paper describes the protocol for the clinical assessment of SFQX in CHF (heart kidney Yang deficiency syndrome) patients.  A randomized, double blind, parallel group, placebo controlled, multi center trial will assess the efficacy and safety of SFQX in the treatment of CHF. 352 patients with CHF (heart kidney Yang deficiency syndrome) from 22 hospitals in China will be enrolled. Besides their standardized western medicine, patients will be randomized to receive treatment of either SFQX or placebo for 12 weeks. The primary outcome is the plasma N terminal pro B type natriuretic peptide levels, which will be measured uniformly by the central laboratory. The secondary outcomes include composite endpoint events (hospitalization due to worsening HF, all cause mortality, other serious cardiovascular events) echocardiography indicators, grades of the New York Heart Association (NYHA) functional classification, the 6 minute walk test (6MWT) results, Minnesota Living With Heart Failure Questionnaire and TCM syndrome scores.  The integrated TCM and western medicine therapy has developed into a treatment model in China. The rigorous design of the trial will assure an objective and scientific assessment of the efficacy and safety of SFQX in the treatment of CHF.

title: Current status of heart failure in China
abstract: As a serious and terminal stage of multiple cardiovascular diseases, heart failure (HF) is one of the most critical components of the current global strategies for the prevention and management of chronic diseases. With aging and the increased incidence of various cardiovascular diseases and related risk factors in the population, HF has also become a main reason for hospitalization and death of the elderly in China, which has resulted in a heavy burden on public health system and the economy. A 2003 report suggested that the prevalence of HF in China was 0.9% higher in women than in men, and is increasing in proportion with aging. Although the mortality rate of HF seen in hospitals has declined, the long term prognosis of HF in China is discouraging as demonstrated by a 3 year mortality rate of approximately 30% HF diagnosis by brain natriuretic peptide, N terminal pro B type natriuretic peptide, and echocardiography in China is unsatisfactory. Room for improvement is needed in drug and nondrug HF treatment in China. Intensive efforts are also needed to promote a real world use of the current guidelines for recommended drugs that could improve HF patients' prognosis, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and b blockers. Much work is also needed to embrace the concept of HF management and systems in China. In the future, more attention should also be given to domestic epidemiological and clinical study of HF, focusing on transformation of experimental results to a clinic setting, and ongoing recognition of and attention to HF preserved ejection fraction. An efficient HF management system in China should also highlight the importance of establishing the most cost effective prevention and therapy strategies.

title: Research progress on self management needs of elderly patients with chronic heart failure
abstract: This paper reviewed the content and assessment tools of self management needs in elderly patients with chronic heart failure according to diversified demand, current status of self management and existing problems of them so as to provide a reference for developing the practice in self management needs among elderly patients with chronic heart failure in China.  Chronic heart failure; Self management; Needs

title: Yiqi Fumai Injection as an Adjuvant Therapy in Treating Chronic Heart Failure: A Meta Analysis of 33 Randomized Controlled Trials
abstract: Fumai injection (YQFM) is a traditional Chinese medicine widely used for cardiovascular diseases in China. This systematic review aimed to evaluate whether YQFM could be an effective and safe complementary therapy for chronic heart failure (CHF)  Eight electronic literature databases were searched up to March 31, 2020. Randomized controlled trials (RCTs) comparing YQFM conventional treatment with conventional treatment alone for CHF were included. The primary outcome was response to treatment, which was graded by improvements in heart function based on the New York Heart Association (NYHA) criteria, while the secondary outcomes included the left ventricular ejection fraction (LVEF) cardiac output, left ventricular end systolic diameter (LVESD) amino terminal pro brain natriuretic peptide (NT proBNP) 6 minute walk test performance (6MWT) quality of life (QoL) as assessed by the Minnesota Living with Heart Failure questionnaire, and adverse reactions. Data from individual RCTs were pooled by a random effects meta analysis with effect measures of proportional odds ratios (pORs) and 95% confidence intervals (95% CIs) for the ordinal outcomes and the mean difference (MD) and 95% CI for the continuous outcomes.  In total, 33 RCTs involving 3070 patients with an overall moderate to high risk of bias were selected. The meta analysis showed that compared with conventional treatment alone, YQFM plus conventional treatment had a significantly higher likelihood of improving the response to treatment (pOR 1.88, 95% CI 1.47 to 2.42, I2 0% YQFM also significantly improved the LVEF (MD 5.53% 95% CI 4.73 to 6.33, I2 82% cardiac output (MD 0.32 L/min, 95% CI 0.19 to 0.45, I2 47% and LVESD (MD 3.73 mm, 95% CI 5.51 to 1.95, I2 22% reduced the NT proBNP levels (MD 341.83 pg/mL, 95% CI 417.89 to 265.77, I2 88% and improved the 6MWT (MD 61.86 m, 95% CI 45.05 to 78.67, I2 64% and QoL (MD 9.82, 95% CI 14.17 to 5.46, I2 81% No serious adverse events related to YQFM were reported.  Although limited by a moderate to high risk of bias, the current evidence suggests that YQFM as a complementary treatment significantly improves heart function and related indicators in patients with CHF. The clinical use of YQFM needs careful safety monitoring. Well designed studies are still required to further evaluate the efficacy and safety of YQFM for CHF.

title: Citri Reticulatae Pericarpium protects against isoproterenol induced chronic heart failure via activation of PPARg.
abstract: Accumulated clinical trials and animal studies showed that Qiliqiangxin (QLQX) a traditional Chinese medicine formula containing extracts of 11 herbs, exerts beneficial effects on chronic heart failure (HF) Citri Reticulatae Pericarpium (CRP) one herbal medicine in QLQX, has been widely used in treatment against digestive, respiratory and cardiovascular diseases (CVDs) in China. However, the cardiac protective effects and mechanisms of CRP are still unclear.  The effects of CRP were investigated in isoproterenol (ISO) induced chronic HF mice model and neonatal rat ventricular cardiomyocytes (NRVMs) treated with ISO. Echocardiography was used to determine cardiac function. Hematoxylin eosin (HE) staining and a actinin immunofluorescent staining were used to measure cardiomyocyte size. Cardiac fibrosis was evaluated by Masson's trichrome staining. The expression of atrial natriuretic polypeptide (ANP) and brain natriuretic polypeptide (BNP) were determined by quantitative real time PCR (qRT PCR) Western blot was applied to examine the expression of peroxisome proliferator activated receptor gamma (PPARg) PPARg coactivator 1a (PGC 1a) fibrosis related and apoptosis related proteins.  We found that CRP could significantly attenuate ISO induced cardiac dysfunction, inhibit cardiac pathological hypertrophy and alleviate myocardial fibrosis and apoptosis. Mechanistically, the downregulation of PPARg and PGC 1a in ISO injected mice hearts and ISO treated NRVMs could be reversed by CRP treatment. The beneficial effects of CRP against ISO induced HF were abolished by PPARg inhibitor (T0070907) suggesting that CRP mediated PPARg upregulation was essential for the preventive effect of CRP on ISO induced cardiac dysfunction.  In conclusion, our study demonstrated that CRP attenuates ISO induced cardiac remodeling via PPARg activation, which represents a new application for CRP in the prevention of chronic HF.

title: The discovery of Q markers of Qiliqiangxin Capsule, a traditional Chinese medicine prescription in the treatment of chronic heart failure, based on a novel strategy of multi dimensional "radar chart" mode evaluation.
abstract: Qiliqiangxin Capsule (QLQX) a traditional Chinese medicine (TCM) prescription, is especially used for clinical treatment of chronic heart failure (CHF) in China. However, the holistic quality control of QLQX has not been well established due to lack of system research on the quality marker (Q marker) PURPOSE In this study, a new strategy of multi dimensional "radar chart" mode was proposed to overcome the problem that traditional methods cannot evaluate the multiple properties of Q markers comprehensively and visually, and the strategy was successfully applied to discover the Q markers of QLQX.  First, nineteen prototypes that entered the in vivo systemic circulation were selected out as the candidate Q markers based on our previous studies of chemical and in vivo metabolic profiles. Then, their contents in QLQX were quantitatively analyzed by UHPLC MS/MS, and the bioactivities on the H9c2 cardiomyocytes cell model was evaluated. The network of in vivo component target closely related to CHF was further constructed. Finally, a multi dimensional "radar chart" mode was developed and corresponding Regression Area (RA) and Coefficient Variation (CV) were calculated after data standardization and integration visually based on the Q marker related multiple characteristics (including the compatibility contribution of herbal medicines, the content, the bioactivity, the in vivo predicted bioavailability and the degree of network pharmacology of candidate components in the TCM prescription)  By comparison of RA and CV of the chemicals in the "radar chart" seven compounds mainly from King and Minister herbs (songorin, calycosin 7 O b D glucopyranoside, astragaloside, tanshinone IIA, ginsenoside Re, hesperidin and alisol A) were screened out as the Q markers of QLQX, showing the reasonable compatibility contribution and high content in QLQX, preferable pharmacological effect on CHF, as well as good bioavailable characteristics and high target hits in system pharmacology.  The Q marker discovery of QLQX in this study laid an important foundation for its quality control improvement, and the mode standardized the abstract definitions of Q marker and realized the comprehensive assessment of multiple properties of Q marker in TCM prescriptions, which has a reference value for revealing the Q marker in the quality control researches of TCM prescriptions.

title: Effect of advanced nursing care on psychological condition in patients with chronic heart failure
abstract: This study will appraise the effect and safety of advanced nursing care (ANC) on psychological condition (PC) in patients with chronic heart failure (CHF)  The following databases will be sought from the beginning up to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, the Chinese Scientific Journal Database, and China National Knowledge Infrastructure. There are not language and publication status limitations related to any electronic databases. In addition, we will also identify conference proceedings, reference lists of included studies, and websites of clinical trials registry. Two reviewers will separately carry out study selection, data extraction, and study quality evaluation. Any inconsistencies will be solved by a third reviewer through discussion. RevMan 5.3 software will be utilized to carry out statistical analysis.  This study will comprehensively summarize all potential evidence to systematically address the effects and safety of ANC on PC in patients with CHF.  The findings of the present study will help to determine whether ANC is effective or not on PC in patients with CHF.

title: Effect of grelin on TRX expression in chronic heart failure tissue
abstract: The aim of this study is to explore the effect of grelin on TRX expression (TRXE) in chronic heart failure tissue (CHFT)  We will search electronic databases from inception to the March 1, 2020 in MEDLINE, EMBASE, Cochrane Library, CINAHL, PEDro, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will not apply any limitations to the language and publication status. Any randomized controlled trials (RCTs) that studied the effect of grelin on TRXE in CHFT will be included. Study quality will be checked by Cochrane risk of bias and evidence quality will be appraised by Grading of Recommendations Assessment Development and Evaluation. All extracted data will be analyzed by RevMan 5.3 Software.  This study will summarize the present RCTs to assess the effect of grelin on TRXE in CHFT.  The results of this study will provide conclusive evidence of the effect of grelin on TRXE in CHFT.

title: Predictors of rehospitalisation for community dwelling older adults with chronic heart failure: A structural equation model.
abstract: To examine the effects of health literacy, activities of daily living, frailty and self care on rehospitalisation for older adults with chronic heart failure using a structural equation model.  This was a cross sectional study.  Two hundred and seventy one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants.  The proposed model revealed a good fit to the data (kh2 /d.f.=2.39, root mean square error of approximation=0.06, goodness of fit index=0.93, comparative fit index=0.91, normed fit index=0.91. Health literacy (b=0.21) activities of daily living (b=0.43) frailty (b=0.29) and self care (b=0.40) directly affected the rehospitalisation of older patients with chronic heart failure. Health literacy (b=0.19) activities of daily living (b=0.36) and frailty (b=0.33) indirectly affected rehospitalisation through self care. Frailty (b=0.16) indirectly affected rehospitalisation by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalisation; the effect values were 0.43 and 0.57, respectively.  Community dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self care was eligible for rehospitalisation. Self care and activities of daily living were considered mediators between rehospitalisation and its predictors. A future longitudinal study is required to validate the results.  Tailored and targeted measures aiming to enhance self care and activities of daily living have been developed for the older patients with chronic heart failure because they are not only predictors but also mediators. The assessment of health literacy level of this population is the first step before developing health education. The frailty of patients with chronic heart failure should be reduced at a minimum level.

title: Assessment of chronic disease self management in patients with chronic heart failure based on the MCID of patient reported outcomes by the multilevel model
abstract: Assessment of chronic disease self management in patients with chronic heart failure based on 1 the MCID of patient reported outcomes by the multilevel model 2 Jing Tian, Jinghua Zhao, Qing Zhang, Jia Ren, Linai Han, Jing Li, Yanbo Zhang, Qinghua Han a 3 Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, 4 Taiyuan, Shanxi Province 030001, China. 5 Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South 6 XinJian Road, Taiyuan, Shanxi Province 030001, China. 7 Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, 8 Taiyuan, Shanxi Province 030001, China. 9