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

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

Author information

1
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (E.S.S., Y.W., Y.L., X.X., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., Y.W., H.M.K.), Department of Obstetrics and Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Harvard Medical School, Boston, MA (A.L.B.); National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China (X.W., X.D., J.L., L.J.); Johns Hopkins School of Nursing, Baltimore, MD (P.M.D.); University of Colorado Anschutz Medical Campus and the Colorado Cardiovascular Outcomes Research Consortium, Denver (F.A.M.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City (J.A.S.); and Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT (H.M.K.).
2
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (E.S.S., Y.W., Y.L., X.X., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., Y.W., H.M.K.), Department of Obstetrics and Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Harvard Medical School, Boston, MA (A.L.B.); National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China (X.W., X.D., J.L., L.J.); Johns Hopkins School of Nursing, Baltimore, MD (P.M.D.); University of Colorado Anschutz Medical Campus and the Colorado Cardiovascular Outcomes Research Consortium, Denver (F.A.M.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City (J.A.S.); and Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT (H.M.K.). jiangl@fwoxford.org erica.spatz@yale.edu.

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

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