Acupuncture and related therapies used as add-on to conventional treatments for heart failure: A systematic review of pairwise and network meta-analyses

Objective: This study aimed to assess and compare the clinical efficacy and safety of acupuncture and related therapies (ARTs) add-on to conventional treatment (CT) for heart failure (HF) through pairwise and network meta-analyses. Methods: Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wanfang Database were searched from inceptions to December 2017. Randomized controlled trials (RCTs) regarding ARTs combining with CT for HF were eligible. The primary outcomes were changes in heart function classification (HFC) according to New York Heart Association class and left ventricular ejection fraction (LVEF). Risk of bias assessment was conducted by two independent authors. Pairwise and network meta-analyses were performed using STATA 13.0 and WinBUGS 1.4.3 software. Results: A total of 26 RCTs were enrolled for analyses, with 5 kinds of ARTs and 2116 patients in all. Pairwise meta-analyses showed that acupoint application (OR: 3.28, 95% CI[2.26, 4.76]), acupuncture (OR: 2.78, 95% CI[1.21, 6.41]), acupoint injection (OR: 3.33, 95% CI[1.85, 6.00]) and moxibustion (OR: 2.51, 95% CI[1.02, 6.21]) could significantly improve HFC when they were used as add-on to CT. Acupoint application (MD: 3.57, 95% CI[1.45, 5.70]), acupuncture (MD: 7.75, 95% CI[2.33, 13.17]), acupoint injection (MD: 4.81, 95% CI[2.99, 6.63]) and moxibustion (MD: 6.99, 95% CI[3.62, 10.36]) were significantly beneficial in improving LVEF. Network meta-analyses showed that acupoint injection (SUCRA = 70.0%) and acupuncture (SUCRA = 90.4%) respectively had the greatest probability in improving HFC and LVEF. Conclusion: Most of the included ARTs add-on to CT was effective in improving HFC and LVEF. Acupoint injection and acupuncture may respectively have better effect than others for HFC and LVEF. However, due to the small sample size and poor quality of the included studies, hence well-designed RCTs are needed to confirm our findings. (C) 2019 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.