This article is a commentary on:
The efficacy of ginseng-containing traditional Chinese medicine in patients with acute decompensated heart failure: A systematic review and meta-analysis
Niansong Kang1*
Sihui Zheng2- 1Department of Traditional Chinese Medicine, Yuyao Hospital of Traditional Chinese Medicine, Yuyao, Zhejiang, China
- 2Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
by Chen X, Ma Y, Li J, Yao L, Gui M, Lu B, Zhou X, Wang M and Fu D (2023). Front. Pharmacol. 13:1083001. doi: 10.3389/fphar.2022.1083001
The most prominent limitation of this meta-analysis is the inaccuracy of the literature search. In this article, the author emphasized that seven commonly used Chinese and English databases were searched, and the search time point was before July 2022. Finally, 12 articles related to “Shenfu Injection” were included. However, it must be recognized that randomized controlled studies on Shenfu injection and acute heart failure are very abundant in China. Therefore, through the keywords provided by the authors, we reconducted an extensive search for studies related to “Shenfu injection.” Not surprisingly, four eligible studies were omitted by the authors (Tao and Fu, 2013; Jiang et al., 2014; Chen, 2015; Tang and Chu, 2017). Although the conclusions of these five articles are consistent with the authors, a more adequate sample size allows the authors to conduct a deeper analysis of the sources of high heterogeneity in the outcomes. In addition, the authors need to further expand the English database to find English papers as much as possible, and only 3 English databases may miss high-quality target literatures. For example, the authors could add the following English databases: Scopus, Google Scholar, Web of Science, Cochrane Library, and LitCovid.
The high degree of heterogeneity in the primary outcome is another drawback of this meta-analysis. It must be acknowledged that in order to explain the source of heterogeneity, the authors performed valid subgroup analyses according to three possible factors. We would like to provide constructive comments on this massive project to further refine and consolidate the findings of the study. The authors performed subgroup analyses according to treatment period (within or beyond 2 weeks). Whether it is possible to further explore the possible time-effect relationship for some outcomes? For example, BNP or NT-proBNP levels may show a more pronounced trend over time. Secondly, considering the difference of drug dose (such as Shenfu Injection), can we explore the optimal dose for patients with ADHF by adding the missing studies? Third, the results would be further improved if the authors could report left ventricular fractional shortening and TCM syndrome scores. Finally, we recommend using the inverse variance heterogeneity model to verify the stability of highly heterogeneous outcomes in order to dispel the widespread distrust of high heterogeneity (Doi et al., 2015).
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
Chen, J. A. (2015). Shenfu injection combined with Western medicine in treatment of patients with acute heart failure and its effects on plasma NT-proBNP and cardiac function. Int. Med. Health Guid. News 21, 3189–3192. doi:10.3760/cma.j.issn.1007-1245.2015.21.028
Chen, X., Ma, Y., Li, J., Yao, L., Gui, M., Lu, B., et al. (2023). The efficacy of ginseng-containing traditional Chinese medicine in patients with acute decompensated heart failure: A systematic review and meta-analysis. Front. Pharmacol. 13, 1083001. doi:10.3389/fphar.2022.1083001
Doi, S. A., Barendregt, J. J., Khan, S., Thalib, L., and Williams, G. M. (2015). Advances in the meta-analysis of heterogeneous clinical trials I: The inverse variance heterogeneity model. Contemp. Clin. trials 45, 130–138. doi:10.1016/j.cct.2015.05.009
Jiang, W. J., Chen, L. J., Cheng, S. J., and Mo, W. (2014). Observation on the effect of Shenfu injection on patients with acute left heart failure in early stage. J. Guangxi Univ. Chin. Med. 17.
Tang, N., and Chu, Q. M. (2017). Clinical observation of Shenfu injection combined with rhBNP in the treatment of acute heart failure. Chin. J. Integr. Med. Cardio-Cerebrovascular Dis. 15. doi:10.3969/j.issn.1672-1349.2017.14.015
Keywords: ginseng, acute decompensated heart failure, meta-analysis, commentary, review
Citation: Kang N and Zheng S (2023) Commentary: The efficacy of ginseng-containing traditional Chinese medicine in patients with acute decompensated heart failure: a systematic review and meta-analysis. Front. Pharmacol. 14:1180944. doi: 10.3389/fphar.2023.1180944
Received: 30 March 2023; Accepted: 10 July 2023;
Published: 01 August 2023.
Edited by:
Anthony Booker, University of Westminster, United KingdomReviewed by:
Guang Hu, Chongqing University of Technology, ChinaCopyright © 2023 Kang and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Niansong Kang, jiangjianghh1928@126.com