Objective To assess the efficacy and safety of various Chinese patent medicines (CPMs) combined with guideline-directed medicine (GDM) for chronic heart failure (CHF) using network meta-analysis. Methods The randomized controlled trials (RCTs) regarding CPMs for CHF were searched in CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science from inception to July 2025. RevMan 5.4 and Stata16 software were used for quality assessment and network meta-analysis. Results A total of 128 RCTs involving, 15 913cases and seven types of CPMs, with 8 003 cases in the experimental group and 7 910 cases in the control group. Network meta-analysis indicated that CPMs combined with GDM outperformed GDM alone in efficacy without serious adverse reactions. (1) The top CPMs in terms of clinical efficacy were Qili Qiangxin Capsule (芪苈强心胶囊), Shexiang Tongxin Dripping Pill (麝香通心滴丸), and Qishen Yiqi Dripping Pill (芪参益气滴丸). (2) For improving left ventricular ejection fraction (LVEF), the top three were Shensong Yangxin Capsule (参松养心胶囊), Qili Qiangxin Capsule, and Tongxinluo Capsule (通心络胶囊). (3) In the 6-minute walk test (6MWT), the top three were Qishen Yiqi Dripping Pill, Shexiang Tongxin Dripping Pill, and Wenxin Granule (稳心颗粒). (4) For reducing left ventricular end-diastolic dimension (LVEDD), the top three were Shexiang Tongxin Dripping Pill, Wenxin Granule, and Qishen Yiqi Dripping Pill. (5) For reduction in left ventricular end-systolic diameter (LVESD), the top three were Shensong Yangxin Capsule, Tongxinluo Capsule, and Qili Qiangxin Capsule. (6) In terms of improvement in N-terminal pro-brain natriuretic peptide (NT-proBNP), the top three were Qishen Yiqi Dripping Pill, Shexiang Tongxin Dripping Pill, and Qili Qiangxin Capsule. Conclusion The results indicated that the combination of Chinese patent medicines with GDM for heart failure could effectively improve clinical efficacy, enhance cardiac function and exercise tolerance, delay ventricular remodeling, reduce serum markers of heart failure compared to the GDM alone. However, due to limitations in the quality and number of included studies, the above conclusions need further verification through more high-quality RCTs.

Chinese patent medicines  /  guideline-directed medical therapy  /  chronic heart failure  /  network Meta-analysis  /  Qishen Yiqi Dripping Pill  /  Qili Qiangxin Capsule  /  Shensong Yangxin Capsule  /  Shexiang Baoxin Pill  /  Shexiang Tongxin Dripping Pill  /  Tongxinluo Capsule  /  Wenxin Granules