Objective

2

To explore disease/syndrome/symptoms-curative effects-medication rules of traditional Chinese medicine （TCM） in the treatment of patients with stable coronary heart disease （SCHD） in a real-world study.

Methods

2

An information database for TCM diagnosis and treatment was established， and records for pattern differentiation and treatment of SCHD in addition to maintaining the western medicine by TCM experts from different regions of China were tracked for 1 to 2 weeks. The syndrome elements and syndrome types of the included patients were counted before treatment. The TCM syndrome scores were evaluated before and after treatment， and the patients with an improvement rate equaling or exceeding 50% after treatment were regarded as the effective cases. The European five-dimensional health scale including EuroQol-5D （EQ-5D） score and visual analogue （EQ-VAS） score were used to evaluate the patient's health status， and those with improvement rate of EQ-VAS score after treatment exceeding 10% were taken as the effective cases. Chest pain as a typical symptom of CHD was recorded to analyze the effect of the combined application of Chinese herbal medicine.

Results

2

Of the included 2046 patients， there were 2003 cases with definite syndrome elements and 1998 cases with definite syndrome types regarding the diagnosis. Totally， 1953 cases had complete data in terms of the TCM syndrome score， while 1954 cases and 1906 cases had eligible data for EQ-5D and EQ-VAS analyses， respectively. Occurrence of chest pain was recorded in 1826 cases. Before treatment， the top three syndrome elements were blood stasis （1793 cases， 89.5%），

qi

deficiency （1651 cases， 82.4%）， and phlegm turbidity （1428 cases， 71.3%）， and the top three syndrome types were

qi

deficiency and blood stasis （450 cases， 22.5%）， binding of phlegm and stasis （285 cases， 14.3%）， and

qi

deficiency and phlegm stasis （233 cases， 11.7%）. Totally， 672 cases met the effective criteria of TCM syndrome score after treatment， and the effective cases accounted for 37.5%， 30.2%， and 33.0% of all the cases with

qi

deficiency and blood stasis syndrome， binding of phlegm and stasis syndrome， and

qi

deficiency and phlegm stasis syndrome， respectively. A total of 707 cases met the effective criteria of the EQ-VAS score， and the top three frequent herbs were Danshen （

Radix et Rhizoma Salviae Miltiorrhizae

， 484 cases， 68.5%）， Fuling （

Poria

， 420 cases， 59.4%）， and Chuanxiong （

Rhizoma Chuan

-

xiong

， 375 cases， 53.0%）. There were 306 patients whose chest pain symptom disappeared， and for them the top three frequently used herbs were Danshen （207 cases， 67.6%）， Fuling （196 cases， 64.1%）， and Banxia （

Rhizoma Pinelliae

， 162 cases， 52.9%）. Thirty-four herbs were frequently used （＞10%） by patients with chest pain records， and the top six herbs regarding the CI values were Danshen （0.306）， Fuling （0.264）， Chuanxiong （0.226）， Banxia （0.221）， Chenpi （

Pericarpium Citri Reticulatae

， 0.207）， and Chishao （

Radix Paeoniae Rubra

， 0.205）. The linear correlation graph between the frequency of 34 herbs and the occurrence of chest pain showed that higher frequent herb was associated with more reduction of the occurrence rate of chest pain； multivariate regression model showed statistical significance （

P

= 0.028）， and six herbs with higher CI contributed importantly to the decrease of chest pain occurrence， and additive effect was shown among the herbs.

Conclusion

2

This real-world study shows certain disease， syndrome， symptom-curative effect-medication rules of different experts in the pattern differentiation and treatment of SCHD. Danshen， Fuling， Chuanxiong， Banxia， Chenpi and Chishao are the core herbs for decrease the occurrence of chest pain of SCHD patients， and the additive effect between the herbs make it better when combining the herbs than using single herb alone.