[Effect of shengmai injection on hemodynamics in patients with dilated cardiomyopathy]. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure.
To observe the effects of Shengmai Injection (SMI) on hemodynamics in patients with dilated cardiomyopathy (DCM), and to explore the clinical effect of SMI in treating patients of DCM with heart failure.
                One hundred patients were divided into two groups. In the 50 cases of the treated group, 10 cases with heart function of II degree, 35 of III degree and 5 of IV degree. The corresponding number of cases in the 50 patients of the control group were 10, 36 and 4. Conventional treatment was given to both groups, and SMI was administered to the treated group additionally. The therapeutic effect and the indexes of heart function before and after treatment were determined and compared.
                In the treated group, treatment showed markedly effective in 22 cases and effective in 20, the total effective rate being 84%, while in the control group, markedly effective in 14 and effective in 16, the total effective rate being 60%, the comparison between the two groups showed significant difference (chi 2 = 7.14, P < 0.01). In the treated group, cardiac output, stroke volume (SV), cardiac index, eject fraction (EF), lefe ventricular minor axis shortened rate, ventricular wall thickened rate were all increased after treatment and system vascular resistance (SVR) decreased significantly (P < 0.05), while in the control group, insignificant change was found in the above-mentioned parameters after treatment (P > 0.05). Comparison between the two groups after treatment showed that EF and SV were obviously higher and SVR obviously lower in the treated group than those in the control group.
                SMI could markedly improve the heart function of patients with DCM. The effect of conventional treatment would be enhanced in combination therapy with SMI. Heart failure, a condition predominantly affecting the elderly, represents an ever-increasing clinical and financial burden for the NHS. Cardiac rehabilitation, a service that incorporates patient education, exercise training and lifestyle modification, requires further evaluation in heart failure management.
                The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient heart failure clinic (standard care) for patients, over 60 years of age, with chronic heart failure.
                Two hundred patients (60-89 years, 66% male) with New York Heart Association (NYHA) II or III heart failure confirmed by echocardiography were randomised. Both standard care and experimental groups attended clinic with a cardiologist and specialist nurse every 8 weeks. Interventions included exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. The main outcome measures were functional status (NYHA, 6-min walk), health-related quality of life (MLHF and EuroQol) and hospital admissions.
                There were significant improvements in MLHF and EuroQol scores, NYHA classification and 6-min walking distance (meters) at 24 weeks between the groups (p<0.001). The experimental group had fewer admissions (11 vs. 33, p<0.01) and spent fewer days in hospital (41 vs. 187, p<0.001).
                Cardiac rehabilitation, already widely established in the UK, offers an effective model of care for older patients with heart failure.
Shengmai may be beneficial in treating heart failure, especially in terms of improving the NYHA functional classification with Shengmai plus usual treatment. However, the evidence for its effects on mortality and hospitalisation are not available yet. Therefore more studies, of higher quality and long-term follow-up, are needed to provide more evidence for the future use of Shengmai.