Research On Construction Of Guidelines For Intervention On Prevention Of Diseases In Chronic Heart Failure

Objective:According to the results of literature search and expert experience,the "Disease prevention" theory of traditional Chinese medicine(TCM)has been widely used to prevent and treat patients with Chronic heart failure(CHF)in stage B and stage C,including "preventing diseases,complications,and recurrence." After analyzing the characteristics of CHF in stage B and stage C,this study reviewed and summarized the clinical research of TCM evidence.The research on construction of"Guidelines for Intervention on Prevention of Diseases in Chronic Heart Failure" was carried out to provide evidence and support for the application of TCM in the early prevention and prognostic management of CHF.Methods:(1)Define standard questions and key outcome indicators:Through literature pre-search,expert interview and clinical research,a list of standard questions was formed and important outcome indicators were screened out.Based on Delphi method,standard questions and key outcome indicators were determined through 3 rounds of expert consultation questionnaires.(2)Literature search and systematic review:According to the clinical problems,the search strategy and inclusion and exclusion criteria were formulated.Through systematic literature screening,evidence extraction and synthesis of the included studies were carried out.The improved Jadad score and Review Manager 5.3 software were used for literature quality evaluation and systematic review and meta analysis.Evidence was provided for the formation of expert recommendations.(3)Forming expert recommendation opinions:According to the comprehensive results of standard questions and evidence,experts were invited to vote on recommendation opinions by adopting the consensus method at the meeting.Finally,a consensus was reached on the recommendation intensity of TCM intervention measures for curing diseases.Results:(1)After the literature research,expert interview,clinical research and three rounds of consulting expert questionnaire,13 standard questions were determined.These questions covered the three aspects of "Disease prevention" theory.Besides,there were 13 key outcome indicators,which reflected the clinical efficacy and disease progression of patients with CHF in stage B and stage C.(2)Through literature search and screening,28 studies were finally included,including 0 study of CHF in stage B(hypertensive heart disease),8 studies of CHF in stage B(stable coronary heart disease),and 20 studies of CHF in stage C,all of which were high-quality literatures.The results of systematic review showed that TCM decoction,Chinese patent medicine,acupuncture,moxibustion,Tai Chi,Baduanjin and other TCM intervention measures combined with conventional western medicine treatment had a better effect on patients with CHF in stage B and stage C compared with conventional western medicine treatment alone.(3)Through the consensus method of the meeting,experts reached a consensus on the recommended intensity of intervention measures for treating CHF in stage B and stage C with TCM according to the results of evidence evaluation and combined with clinical experience.For CHF in stage B(stable coronary heart disease),there were 2 strong recommendations,including Shexiang Baoxin pills and Qishenyiqi dropping pills,and 5 weak recommendations,including Gualou Xiebai Banxia Decoction,Danlou tablets,broad chest aerosol,Tongmai Yangxin pills,and Baduanjin;For CHF in stage C,there were 6 strong recommendations,including Buyang Huanwu Decoction,ShengMaiSan,Shenfu Decoction,Qiliqiangxin Capsule,Moxibustion,and Baduanjin,and 5 weak recommendations,including Sini decoction,Fangji Huangqi Decoction,Guipi Decoction,acupuncture,and Taijiquan.Conclusion:Based on evidence-based methods,relevant standards in accordance with existing guidelines,and expert research,this study clarified the standard questions and key outcome indicators of the "Guidelines for Intervention on Prevention of Diseases in Chronic Heart Failure," and included high-quality studies through improved Jadad score and GRADE system methods,and conducted meta-analysis and evidence quality grading.Combined with expert experience,A consensus has been reached on the recommendation of intervention measures for treating CHF with TCM.However,the number of clinical studies included in this study was small,the overall sample size was insufficient,the evidence was limited,and the reliability of the results was low.In the future,more high-quality studies are still needed to provide strong evidence for the treatment of CHF for disease prevention.