Qiliqiangxin in patients with heart failure and reduced ejection fraction – the QUEST study

Presented at the ESC Congress 2023 by: Xinli Li, MD, PhD - Nanjing, China

Introduction and methods

In traditional Chinese medicine qiliqiangxin is used for the treatment of HF. Qiliqiangxin comprises of 11 different herbs with active compounds. Qiliqiangxin is thought to have diuretic, vasodilator, and cardiotonic effects. Previous studies demonstrated that qiliqiangxin reduces NT-proBNP levels in patients with HFrEF, and it was suggested that qiliqiangxin upregulates PPAR-ɣ, making it an interesting candidate for HF treatment.

The aim of the QUEST (Qiliqiangxin in heart failure: assessment of reduction in mortality) trial was to investigate whether qiliqiangxin capsules in addition to standard HF therapy improves clinical prognosis in patients with HFrEF compared with placebo.

The QUEST trial was a prospective, randomized, double-blind, placebo-controlled, multi-center trial in which 3110 patients with HFrEF were randomized in a 1:1 ratio to receive four qiliqiangxin capsules three times daily or placebo. 133 centers in China participated in the trial, and most patients wereAsian The primary endpoint was the incidence of a composite of CV death or HF hospitalization. Key secondary outcomes were all-cause mortality, CV death, HF hospitalization, and NT-proBNP decline rate. The median follow-up period was 18.3 months.

Main results

• The risk of the composite endpoint of CV death or HF hospitalization was reduced in the qiliqiangxin group compared with placebo group (HR: 0.78; 95%CI: 0.68-0.90).
• Qiliqiangxin reduced the risk of each component of the composite endpoint (for HF hospitalization HR: 0.76; 95%CI: 0.64-0.90; and for CV death HR: 0.83; 95%CI: 0.68-0.996).
• The effect of qiliqiangxin on the composite endpoint was consistent across various subgroups, which included patients with ischemic etiology (HR: 0.76; 95%CI: 0.65-0.88; P<0.001), patients who were not treated with RAASi+betablokker+MRA (HR: 0.74; 95%CI: 0.60-0.93; P=0.003), and patients with or without baseline ARNI use (HR: 0.84; 95%CI: 0.70-1.00; P=0.041; HR: 0.77; 95%CI: 0.62-0.95; P=0.012, respectively).
• There was no significant increase in serious adverse events and study drug-related adverse events in the qiliqiangxin group compared with the placebo group.

Conclusion

In the QUEST trial, the addition of qiliqiangxin to standard HF therapy reduced the risk of CV death or HF hospitalization by 22% compared with placebo in patients with HFrEF. Moreover, qiliqiangxin was safe and well tolerated in patients.

- Our reporting is based on the information provided at the ESC Congress 2023 -