Clinical Research Papers:
Improved medical expenditure and survival with integration of traditional Chinese medicine treatment in patients with heart failure: A nationwide population-based cohort study
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Abstract
Ming-Yen Tsai1,2, Wen-Long Hu2, Jen-Huai Chiang3,4, Yu-Chuen Huang5, Shih-Yu Chen6, Yu-Chiang Hung2, Yung-Hsiang Chen1,7
1 Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
2 Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
3 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
4 College of Medicine, China Medical University, Taichung, Taiwan
5 Department of Medical Research, China Medical University Hospital and School of Chinese Medicine, China Medical University, Taichung, Taiwan
6 School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
7 Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
Correspondence to:
Yu-Chiang Hung, email:
Yung-Hsiang Chen, email:
Keywords: traditional Chinese medicine, heart failure, NHIRD, medical expenditure, survival
Received: May 17, 2017 Accepted: July 29, 2017 Published: August 08, 2017
Abstract
Background: No previous studies have evaluated the effects of traditional Chinese medicine (TCM) treatment on patients with heart failure (HF). Hence, in this study, we determined whether TCM treatment affects the healthcare burden and survival of HF patients.
Methods: Samples were retrieved from the registry of catastrophic illness patients of the Taiwan National Health Insurance Research Database (NHIRD). Based on a frequency (1:1) matched case-control design, patients with HF between 2000 and 2010 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with HF was analyzed.
Results: Among these patients, 312 used TCM for HF treatment and exhibited significantly increased 5-year survival (p < .0001), with multivariate adjustment, compared with those without TCM use. Mean outpatient clinic visits at 1 year and 5 years after HF diagnosis were higher in TCM users, and accumulated medical costs were lower than in non-TCM users at 1 year. The hospitalization cost at 1-year follow-up was lower for TCM users than for non-TCM users. We found that, compared with non-TCM users, TCM users had an 86% reduction in risk of mortality in the compensated group, and a 68% reduction in the decompensated group receiving TCM treatment (aHR 0.32, 95% CI 0.20–0.52). The hazard ratio (HR) of Chinese herbal medicine (CHM) users with HF was significantly lower than that of non-users (aHR 0.24, 95% CI 0.16–0.35). We also analyzed the most commonly used herbal products as well as the HRs associated with their use, thus providing future research avenues.
Conclusions: This nationwide retrospective cohort study finds that combined therapy with TCM may improve survival in HF patients. This study also suggests that TCM may be used as an integral element of HF interventions on health care costs.
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