System Evaluation Of TCM Therapy For Atrial Fibrillation

ObjectivesTo comprehensively and systematicly evaluate randomized controlled trials and non-randomized controlled study of the literature of Chinese medicine treatment of atrial fibrillation by using evidence-based medicine methods, including the research overview, current problems and deficiencies, the overall significance of the study,;And to perform one appropriate Meta-analysis of randomized controlled studies, to play a valuable guide for the future of Chinese medicine treatment of atrial fibrillation randomized controlled clinical studies.Methods1. Traditional Chinese medicine combines system evaluation of atrial fibrillation.Clinical research literature for the medical treatment of atrial fibrillation was selected, which were controlled (RCTs and non-RCTs) studies and published in the domestic and international medical journals from1978to March,2014. The appropriate evaluation form was made, comprehensive and systematic evaluation was conducted. To establish a database by using Excel, data entry and proofreading was performed by two person, statistical analysis was performed by using SPSS16.0software.2. Traditional Chinese medicine combine Meta analysis of atrial fibrillationClinical research literature for the medical treatment of atrial fibrillation was selected, including journals, magazines, compilation, conference papers and papers and other documents, which were RCTs and published in the domestic and international medical journals from1978to March,2014. To conduct the Meta-analysis of randomized controlled trials by selecting the consistent indicators of efficacy evaluation and main measures in treatment group were using the pure Chinese medicine or Western medicine therapy, while in the control group was regular and standard Western medicine positive control. Then to produce forest plot and funnel plot. All the analysises were conducted by using use the software of Revman5.2.Result1. Appraise systematicallyThrough six domestic and international electronic databases and manual searches, and one by one to read, and ultimately obtain174literatures, including three foreign literatures. All research included in the average sample size was87cases. Randomized controlled study of literature belonging to have150(86.2%), mostly single-center and small sample size study. There is a clear description of the random method used has eight studies, accounting for4.6%; method described as a randomly generated have23completely random, accounting for13.2%; while for a thorough study of occult randomly assigned only one. In the establishment of a blinded, single-blind have six, double-blind have only one, unused blinding have143, accounted for3.4%,0.6%, and82.2%respectly. In Studies included, there are27research groups which gave the number of exit, lost and off for each group, accounting for15.5%.64studies clearly pointed to the appropriate follow-up, accounting for36.8%. Report fully gave each group the number of adverse events or reactions occur, and conducted a statistical analysis and comparison are22, accounting for12.6%. Lack of multi-center, large sample size, randomized controlled study.2. Meta analysisMeta-analysis assessment indicators of Chinese medicine treatment of atrial fibrillation included clinical efficacy, cardioversion of atrial fibrillation rate, sinus rhythm maintenance rate, average heart rate, P wave dispersion, left atrial diameter and thromboembolism rate. Eventually Randomized controlled clinical studies52,4132cases were included, cases in which the treatment group2238cases,1894cases of the control group, by Jadad score,2points are36, there are15three points, four points are one. Meta-analysis showed that, compared with conventional Western medical therapy, Chinese medicine (including Chinese medicine or Western medicine therapy including) in the overall efficiency of the treatment of atrial fibrillation, atrial cardioversion rates have certain advantages. Compared with conventional Western medical therapy alone, pure Chinese medicine and Western medicine therapy were in sinus rhythm maintenance therapy in atrial fibrillation, controlling average or resting heart rate, decreasing left atrial diameter, reducing the P wave dispersion and reducing thromboembolism rate, but no significant difference in the former effectively, which is valid and there are significant differences. Sensitivity analysis and publication bias test results showed that the existence of a certain publication bias of this Meta analysis.ConclusionThe literature overall quality was poor; including Chinese medicine treatment of atrial fibrillation randomized controlled clinical studies and non-randomized controlled studies. Currently large sample, multi-center, double-blind, randomized placebo controlled studies are lacked. Compared with conventional Western medical treatment, Chinese medicine (including Chinese medicine or Western medicine therapy including) in the overall efficiency of the treatment of atrial fibrillation, atrial cardioversion rates have certain advantages. Compared with conventional Western medical therapy alone, pure Chinese medicine in the treatment of atrial fibrillation to sinus rhythm maintenance, controlling average or resting heart rate, decreasing left atrial diameter, reducing the P wave dispersion and the rate of thromboembolism has some efficacy but no obvious advantage, which may be due to the small sample size, shorter observation time. Chinese and Western medicine therapy efficacy appeal indicators, compared with conventional Western medical therapy alone, highlighting some advantages. However, due to the quality of included randomized controlled clinical study of literature is not very high in the Meta-analysis, the poor homogeneity of different clinical studies. Publication bias in the Meta-analysis of the results is possible.