Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China

Circ Cardiovasc Qual Outcomes. 2018 Mar;11(3):e004190. doi: 10.1161/CIRCOUTCOMES.117.004190.

Abstract

Background: Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI).

Methods and results: We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%; P<0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98-4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality.

Conclusions: Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world's most populous country.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Keywords: Chinese traditional; Salvia miltiorrhiza; cardiovascular diseases; complementary therapies; medicine,; quality of health care.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Intravenous
  • Aged
  • China
  • Drugs, Chinese Herbal / administration & dosage*
  • Drugs, Chinese Herbal / adverse effects
  • Female
  • Health Status
  • Hemorrhage / etiology
  • Hospital Mortality
  • Hospitals* / trends
  • Humans
  • Male
  • Medicine, Chinese Traditional / methods*
  • Medicine, Chinese Traditional / trends
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Patient Safety
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Drugs, Chinese Herbal

Associated data

  • ClinicalTrials.gov/NCT01624883