The effects of moxibustion in chronic heart failure patients: a systematic review and meta-analysis

TL;DR

This study reviews and analyzes the effectiveness of moxibustion as an additional treatment for chronic heart failure, finding it improves heart function and quality of life.

Contribution

A systematic review and meta-analysis of moxibustion's clinical efficacy in chronic heart failure patients using large-scale RCT data.

Findings

Moxibustion improved clinical efficacy rate, LVEF, CO, and 6MWT in CHF patients.

NT-proBNP levels decreased, but results were unstable and require further validation.

Subgroup analysis showed treatment duration and moxibustion points influenced outcomes.

Abstract

Moxibustion has been utilized in China for 2,000 years as a safe and straightforward intervention for chronic heart failure (CHF). Numerous articles indicate that moxibustion enhances quality of life and certain heart failure indicators in CHF patients; however, there is a deficiency of high-quality, evidence-based studies with large sample sizes. Our objective was to systematically summarize and assess the clinical efficacy of moxibustion as an adjunctive treatment for CHF.

A thorough search was performed across the PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Network Database, Vipers Database, Wanfang, and China Biomedical Literature Database from their inception until 1 August 2024. A meta-analysis of randomized controlled trials was utilized to aggregate the pooled metrics in patients with chronic heart failure (CHF) and to compare the clinical efficacy rate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), 6 min walk test (6MWT), and cardiac output (CO) variations between standard CHF treatment and standard treatment combined with moxibustion for CHF.

The study encompassed 22 randomized controlled trials (RCTs) involving 2,039 participants, with 1,021 in the experimental group and 1,018 in the control group. The experimental group exhibited a superior clinical efficacy rate compared with the control group (RR = 1.230, 95% CI: 1.173–1.289, p < 0.05), reduced NT-proBNP levels [standardized mean difference (SMD) = −1.035, 95% CI: −1.730 to −0.340, p < 0.05], enhanced LVEF (SMD = 0.909, 95% CI: 0.704–1.114, p < 0.001), improved 6MWT (SMD = 0.909, 95% CI: 0.704–1.114, p < 0.001), and increased CO (SMD = 1.0873, 95% CI: 0.882–1.293, p < 0.001). Following the application of funnel plots and the trim-and-fill method, the findings regarding clinical efficacy rate, LVEF, 6MWT, and CO were deemed reliable, whereas the results for NT-proBNP were found to be unstable. Subgroup analysis revealed that the number of moxibustion points contributed to heterogeneity in LVEF, 6MWT, and CO, while treatment duration accounted for heterogeneity in 6MWT.

The study demonstrates that, in comparison with standard treatment, the integration of moxibustion for CHF patients markedly enhanced the efficacy rate, LVEF, CO, and 6MWT and may reduce NT-proBNP levels, but this result requires further validation with larger sample sizes and standardized testing methods.

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42022372386).

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