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Objective This study aimed to assess and compare the clinical efficacy and safety of acupuncture and related therapies (ARTs) add-on to conventional treatment (CT) for heart failure (HF) through pairwise and network meta-analyses. Methods Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wanfang Database were searched from inceptions to December 2017. Randomized controlled trials (RCTs) regarding ARTs combining with CT for HF were eligible. The primary outcomes were changes in heart function classification (HFC) according to New York Heart Association class and left ventricular ejection fraction (LVEF). Risk of bias assessment was conducted by two independent authors. Pairwise and network meta-analyses were performed using STATA 13.0 and WinBUGS 1.4.3 software. Results A total of 26 RCTs were enrolled for analyses, with 5 kinds of ARTs and 2116 patients in all. Pairwise meta-analyses showed that acupoint application (OR: 3.28, 95%CI[2.26, 4.76]), acupuncture (OR: 2.78, 95%CI[1.21, 6.41]), acupoint injection (OR: 3.33, 95%CI[1.85, 6.00]) and moxibustion (OR: 2.51, 95%CI[1.02, 6.21]) could significantly improve HFC when they were used as add-on to CT. Acupoint application (MD: 3.57, 95%CI[1.45, 5.70]), acupuncture (MD: 7.75, 95%CI[2.33, 13.17]), acupoint injection (MD: 4.81, 95%CI[2.99, 6.63]) and moxibustion (MD: 6.99, 95%CI[3.62, 10.36]) were significantly beneficial in improving LVEF. Network meta-analyses showed that acupoint injection (SUCRA = 70.0%) and acupuncture (SUCRA = 90.4%) respectively had the greatest probability in improving HFC and LVEF. Conclusion Most of the included ARTs add-on to CT was effective in improving HFC and LVEF. Acupoint injection and acupuncture may respectively have better effect than others for HFC and LVEF. However, due to the small sample size and poor quality of the included studies, hence well-designed RCTs are needed to confirm our findings. This study was registered in PROSPERO, CRD42018087700.

Background An increasing number of network meta-analyses (NMAs) in traditional Chinese medicine (TCM) have been published recently, but the quality of them was lack of assessment. This study aims to evaluate the methodological and reporting quality of NMAs in TCM. Methods Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, China National Knowledge Infrastructure (CNKI), Wanfang and Chinese Biomedical Literature Database (CBM) from inception to January 2018, were searched. NMAs of TCM were included. A measurement tool to assess the methodological quality of systematic reviews (AMSTAR) and the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) were used to assess the methodological and reporting quality of the included NMAs. Results A total of 40 NMAs, including 2535 randomized controlled trials (RCTs), were included. They were published between December 2012 and November 2017. The median score and interquartile range of methodological and reporting quality was 7 (6–8) and 22 (19.1–27.1). Serious methodological flaws existed in the following aspects: the status of publication (22.5%), a list of studies provided (0%), assessment of publication bias (37.5%), and conflicts of interest (12.5%). Several items need to be improved in reporting, especially for Protocol and registration (2.5%), Data items (22.5%), Risk of bias across studies (Methods section) (37.5%), Results of individual studies (27.5%), Risk of bias across studies (Results section) (40%), Results of additional analyses (35%), and Funding (15%). Conclusions The methodological and reporting quality of NMAs in TCM is moderate. Identified shortcomings of published NMAs should be taken into consideration in further trainings of authors and editors of NMAs in TCM. Future researchers should be encouraged to apply PRISMA-NMA, and a recognized tool for the assessment of NMA methodology was wanted.

Background: Chinese herbal injections (CHIs) have been commonly used in the treatment of unstable angina pectoris (UAP) in China. However, there is no consensus or evidence on how to select CHIs for patients with UAP. The choice often depends on the personal experience or preference of clinician. This study aims to compare the effect of different CHIs for UAP using Bayesian network meta-analysis (NMA). Methods: A systematic search will be conducted in PubMed, the Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Data from inception to February 2018. We will include randomized controlled trials (RCT) regarding CHIs in the treatment of UAP. Quality of included RCTs will be assessed according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed with WinBUGS 14 to compare the efficacy of different CHIs. GRADE will be used to assess the quality of evidence. Results: The results of this NMA will be submitted to a peer-reviewed journal for publication. Conclusion: Our study will generate evidence for CHIs in the treatment of UAP and help clinicians make more accurate therapeutic schedule. In addition, it might provide suggestions for Chinese medicine clinical practice or guideline.

Background Chinese herbal injections (CHIs) are commonly used for the treatment of heart failure in China. Due to the variety of CHIs used in clinic, selecting a suitable CHI for patients with heart failure is vital. This study aims to assess and compare the effect of different CHIs for heart failure using network meta-analysis (NMA). Methods Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials, Embase, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database will be search from inception to January 2018. Randomized controlled trial (RCT) comparing CHI with another CHI will be included. The primary outcome will be changes in heart function classification and left ventricular ejection fraction. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed using WinBUGS 14 software and the result figures will be generated using Stata 13 software. GRADE will be used to explore the quality of evidence. Results The results of this NMA will be published in a peer-reviewed journal. Conclusion Our study will generate evidence of CHIs for patients with heart failure and provide suggestions for Chinese medicine clinical practice or guideline. Ethics and dissemination Ethics approval and patient consent are not required because this study is an NMA based solely on the published literature. The results of this NMA will be submitted to a peer-reviewed journal. Protocol registration number PROSPERO CRD 42018086740.