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Heart failure is a growing global health concern, and traditional Chinese medicine formulas containing Astragalus (a widely used medicinal herb) have been increasingly studied as potential add-on treatments. Despite their clinical use, no comprehensive synthesis of the evidence had previously been conducted to compare the relative benefits of different Astragalus-containing preparations.
Researchers performed a systematic review and network meta-analysis, searching six databases for randomised controlled trials published up to May 2025. Eighteen trials involving 1,584 patients with heart failure and sixteen different Astragalus-containing traditional Chinese medicine formulas were included. A bias assessment was conducted using the Cochrane Quality Assessment Manual, and network meta-analysis allowed indirect comparisons across multiple treatments simultaneously.
The analysis found that, compared with conventional Western medicine alone, combining Astragalus-containing traditional Chinese medicines with conventional Western medicine generally produced better outcomes across several measures. Different formulas appeared to excel in different areas: Astragalus Granule combined with conventional Western medicine ranked highest for overall clinical effectiveness and for reducing B-type natriuretic peptide (a marker of heart stress), while other formulas showed advantages for exercise capacity, quality of life, and heart structure and function measures. No single formula dominated across all outcomes.
The authors caution that the included studies were limited in number and methodological quality, and that further well-designed, double-blind randomised controlled trials are needed to confirm these findings. Conclusion: Astragalus-containing traditional Chinese medicine formulas used alongside conventional Western medicine appear to offer additional benefits for heart failure patients, though the evidence base currently remains too limited to draw firm clinical conclusions.
Source: Rui F, Di Y, Li C et al. Medicine (2026). View on PubMed (PMID 42216323) · doi:10.1097/MD.0000000000049013