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Hot Line: Does qiliqiangxin improve CV outcomes in patients with HFrEF?

27 Aug 2023

In a Hot Line session yesterday, Professor Xinli Li (The First Affiliated Hospital of Nanjing Medical University - Nanjing, China) presented results from QUEST, the first large-scale, randomised, double-blind, controlled trial of a traditional Chinese medicine for the treatment of chronic heart failure with reduced ejection fraction (HFrEF).


Qiliqiangxin is a traditional Chinese medicine extract obtained from astragalus, ginseng, monkshood, danshen, pepperweed seed, Rhizoma Alismatis, Radix Polygonati Officinalis, cassia twig, red flower, Cortex Periplocae and tangerine peel.1 In a pilot study, qiliqiangxin reduced NT-proBNP levels and improved symptoms in patients with HFrEF when added to established HF treatment.2

The QUEST trial was conducted in 133 hospitals in mainland China and Hong Kong SAR of China. Patients with LVEF 40% and NT-proBNP 450 pg/mL on stable standardised treatment for at least 2 weeks were randomised to also receive qiliqiangxin (4 capsules, 3 times daily) or placebo. Across the 3,110 patients in the analysed population, the average age was 62 years and 72% were men. Mean LVEF was 32% and median NT-proBNP was 1731 pg/mL. Median follow up was 18.3 months.

The primary endpoint of rehospitalisation for worsening HF or CV death occurred in 25.02% of patients with qiliqiangxin and 30.03% with placebo (hazard ratio [HR] 0.78; 95% CI 0.68 to 0.90; p<0.001).

The beneficial effect of qiliqiangxin was related to both lower risks of rehospitalisation for worsening HF (HR 0.76; 95% CI 0.64 to 0.90; p=0.002) and CV death (HR 0.83; 95% CI 0.68 to 0.996; p=0.045). Effects on the primary outcome were generally consistent across prespecified subgroups including those defined by age, NT-proBNP level and angiotensin receptor/neprilysin inhibitor treatment.

The decrease in NT-proBNP between baseline and 3-month follow-up was greater with qiliqiangxin versus placebo (-444 versus -363 pg/mL; p=0.047), but there was no significant difference in all-cause mortality (14.21% versus 16.85%; HR 0.84; 95% CI 0.70 to 1.01; p=0.058). Qiliqiangxin capsules were well tolerated, with no major differences between the groups in adverse events including gastrointestinal symptoms, worsening renal function and increased liver enzymes.

“Our findings demonstrate meaningful clinical benefit with qiliqiangxin in patients with HFrEF, which support the use of qiliqiangxin as an adjunct therapy for treating HF,” concludes Prof. Li.


  1. Yao W, et al. BMC Complement Med Ther. 2020;20:38.
  2. Li X, et al. J Am Coll Cardiol. 2013;62:1065−1072.