Angina & Heart Disease (2020)

Overview

Angina

Background

Angina is experienced as chest pain and is a symptom of coronary heart disease (Huang 2019). Usual care includes medication to control and prevent angina and lifestyle changes in most cases. Some patients may require coronary angioplasty or heart bypass surgery (BHF 2020).

Several systematic reviews of RCTs have shown acupuncture to be beneficial for angina and that it might be used in combination with medication to optimise outcomes

Systematic Reviews

• A systematic review of acupuncture in the management of angina due to coronary artery disease (24 RCTs) concluded that acupuncture in combination with standard care significantly increased the effective rate (P<0.001) (Huang 2019).
• A review of 17 trials in patients with stable angina pectoris (n= 1,516) found that true acupuncture reduced the frequency of angina attacks and improved depression and anxiety levels compared with sham treatment or standard care alone (P<0.00001 for all) (Yang 2019).
• A systematic review of 16 RCTs found that acupuncture, both alone and in combination with medication, improved angina symptoms and reduced the occurrence of acute myocardial infarction (heart attack) compared with medication alone. It is important to note that there was a longer onset to action with acupuncture compared with medication (Chen 2012).
• A review of 12 RCTs (n=974) showed that both acupuncture alone (P<0.00001) and acupuncture in combination with medication (P=0.03) were associated with improved angina symptoms and electrocardiographic (ECG) results compared to medication alone. Nitroglycerin intake was lower with acupuncture plus medication compared with medication alone (P=0.03) (Liu 2019).
• Pooled results from 25 RCTs of acupuncture for angina (n=2,058) showed that fewer patients experienced ineffective angina relief or no improvement on the ECG with acupuncture plus medication compared with medication alone (P<0.00001) (Yu 2015).

Atrial fibrillation

Background

A cardiac arrhythmia is a problem with the rate or rhythm of the heartbeat and the most common type is atrial fibrillation (AF) which is linked to an increased risk of stroke and heart failure (National Heart, Lung and Blood Institute 2014). AF is characterised by a fast and irregular ventricular rate, causing palpitations (Fei 2019). Beta blockers and anti-arrhythmic drugs are common treatments and procedures such as ablation, cardioversion or having a pacemaker fitted may be required (BHF 2020).

Systematic Reviews

• A systematic evaluation of eight studies of acupuncture in patients with AF (n=633) found that it increased the total efficacy and the rate of AF cardioversion to sinus rhythm (P<0.05), and decreased time to this conversion (P<0.05) (Fei 2019).
• A systematic review of 10 trials of acupuncture for arrhythmias had shown that it was similar to medication and better than controls in managing AF (Kim 2011).
• The effectiveness of acupuncture for the treatment of supraventricular tachycardia (a fast heart rhythm) was systematically reviewed with five RCTs (n=323). Compared with the control group, acupuncture reduced heart rate, and the clinical effective rate was superior to angina medication (diltiazem) (Wen 2014).

Clinical Trials

• A recent RCT found that acupuncture combined with amiodarone is superior to amiodarone alone in reducing early recurrences of patients with persistent AF after pulmonary vein isolation (Yin 2019).

Coronary heart disease

Background

Coronary heart disease (ischaemic heart disease) is where plaques form in the arteries due to the build up of cholesterol. If the arteries become narrow and hard as a result, the blood supply to the heart is restricted, causing angina and potentially myocardial infarction or heart failure (Huang 2019). Usual care for coronary heart disease includes medication, coronary angioplasty and the insertion of stents, and coronary bypass surgery (BHF 2019).

Reviews

• A review of 17 studies concluded that acupuncture improves the response of the cardiovascular system in patients with cardiovascular disease. Further studies are required to establish how acupuncture can be used in clinical practice (de Lima Pimentel 2018).
• A matched cohort study in Taiwan compared the risk of coronary heart disease in patients with fibromyalgia who received acupuncture with those who did not (n=58,899 in both cohorts).  Acupuncture was shown to significantly reduce the incidence of coronary heart disease in this population, independent of age, sex, comorbidities, and statin use (Wu 2017).
• Heart rate variability (HRV) is a measure of cardiac function that is reduced in patients with stable ischemic heart disease (SIHD) and is predictive of arrhythmic sudden cardiac death. Patients with SIHD were randomized to true acupuncture, sham acupuncture, or waiting-list control (n=151). True acupuncture improved HRV compared to sham acupuncture at 12 weeks (Mehta 2014). Acupuncture has also been to shown to increase HRV in healthy people and in the elderly (Huang 2015; Li 2019).

Heart failure

Background

Heart failure is where the heart is unable to pump blood around the body properly, which leads to tiredness, breathlessness and swollen feet, ankles or abdomen. It can be caused by myocardial infarction, hypertension or disease of the heart muscle (cardiomyopathy) (Lee 2016; Liang 2019; BHF 2019). Medication is the mainstay of heart failure treatment, with some patients receiving a pacemaker or implantable cardioverter defibrillator (BHF 2019).

Systematic Reviews

• A systematic review of 32 RCTs of acupuncture for heart failure (n=2,499) revealed that acupuncture had a higher efficacy rate (P<0.0001), significantly improved left ventricular ejection fraction (P<0.0001), cardiac output (P<0.0001), and 6-minute walk test results (P<0.0001) compared with standard care (Liang 2019.)
• A systematic review of studies looking at acupuncture for heart failure (7 studies, n=287) found that acupuncture may reduce the length of stay in intensive care and the risk of re-admission (Lee 2016).