The clinical efficacy of Astragalus-containing Chinese patent medicines in the effective treatment of heart failure: A systematic review and network meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with heart failure (n=1584 across 18 studies) |
| I — Intervention | Traditional Chinese medicines containing Astragalus, either alone or combined with Western medicine |
| C — Comparator | Western medicine alone or other Astragalus-containing formulations |
| O — Outcomes | Clinical efficacy rate, six-minute walk test, B-type natriuretic peptide levels, NT-proBNP, left ventricular ejection fraction, left ventricular end-diastolic diameter, Minnesota Heart Failure Quality of Life scores |
Bottom Line
This network meta-analysis suggests that adding Astragalus-containing Traditional Chinese medicines to conventional heart failure therapy may improve clinical outcomes across multiple domains. However, the evidence quality is limited by small study numbers, lack of effect size reporting, and absence of certainty assessment. The authors appropriately acknowledge these limitations and call for higher-quality randomised controlled trials. For Australian clinicians, these findings provide preliminary evidence for potential adjunctive benefits of Astragalus formulations, but cannot support routine clinical recommendations given regulatory and evidence limitations. The study highlights the need for rigorous evaluation of traditional medicines using contemporary evidence standards.
Key Findings
P Value: Not reported
Effect Size: Not reported - only SUCRA rankings provided
Primary Outcome: Clinical efficacy rate improved with Astragalus Granule + Western medicine combination
Nnt Or Sensitivity: SUCRA rankings: Astragalus Granule + WM ranked best for overall clinical efficacy; Qiangxin Capsule + WM optimal for six-minute walk test
Confidence Interval: Not reported
Clinical Application
Limited by availability and standardisation of specific Astragalus formulations outside traditional Chinese medicine contexts Not directly applicable to Australian practice - Astragalus formulations not TGA-approved as therapeutic goods; would require individual practitioner assessment under complementary medicine frameworks Heart failure patients, particularly those in healthcare systems where Traditional Chinese Medicine is integrated with conventional care
Abstract
BACKGROUND: The incidence of cardiovascular diseases, particularly heart failure, has been rising year by year. Traditional Chinese medicines containing Astragalus have been widely used in clinical research. However, there is no definitive research on the efficacy of proprietary Chinese medicines containing Astragalus. A network meta-analysis was conducted to investigate the efficacy and safety of oral traditional Chinese medicines containing Astragalus for the treatment of heart failure. METHODS: This study searched 6 databases for clinical randomized controlled trials involving the use of traditional Chinese herbal medicines containing Astragalus alone or in combination with other drugs, with a search period from the establishment of the databases to May 27, 2025. Using the Cochrane Quality Assessment Manual, we conducted a bias analysis of the included studies, and the extracted data were analyzed using network meta-analysis in Stata 18. RESULTS: A total of 18 studies were included, involving 1584 patients with heart failure, with 16 types of traditional Chinese medicines containing Astragalus. The network meta-analysis via Surface Under the Cumulative Ranking Curve analysis indicated that: Compared to using Western medicine (WM) alone, Astragalus Granule + WM ranked best for improving overall clinical efficacy rate; Qiangxin Capsule + WM was optimal for improving six-minute walk test; Astragalus Granule + WM showed the best efficacy for reducing B-type natriuretic peptide levels; Yanxing Decoction + WM ranked first for lowering N-terminal pro-B-type natriuretic peptide levels; Xinlishen Compound + WM was the optimal combination for improving left ventricular ejection fraction; Qili Qiangxin Capsule + WM performed best for reducing left ventricular end-diastolic diameter; Yangxin Tongmai II Prescription + WM exhibited the highest efficacy for decreasing Minnesota Heart Failure Quality of Life Questionnaire scores. CONCLUSIONS: Adding oral traditional Chinese medicine containing Astragalus to WM treatment can further improve the clinical efficacy of heart failure. However, due to the limited number and quality of the included studies in this research, the above conclusions still require further validation through well-designed randomized double-blind controlled trials.
References
- 1.Rui, F., Di, Y., Li, C., Liu, T., & Wu, Y. (2026). The clinical efficacy of Astragalus-containing Chinese patent medicines in the effective treatment of heart failure: A systematic review and network meta-analysis. Medicine, 105(22), e49013. https://doi.org/10.1097/MD.0000000000049013
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