Acupuncture and heart failure

Stimulated by Jun et al 2025.[1]

IF – impact factor
CV – cardiovascular
k – thousand (when written after a numeral)
PSM – propensity score matching
CCI – Charleston comorbidity index
CHA₂DS₂-VASc score – a scoring system that predicts the risk of CV events
AF – atrial fibrillation
aHR – adjusted hazard ratio

– key to acronyms

We have another large retrospective cohort study. This one comes from Iksan, Korea, and is published in Frontiers in Cardiovascular Medicine (IF 2.9). We saw a similar one from the same group that I highlighted in February this year – Acupuncture for CVD in disability.

Again, the group looks at heart failure and mortality, both CV mortality and all-cause mortality. Last time they started with patients who had a disability. This time they selected patients with a new diagnosis of heart failure and at least 2 outpatient visits or hospital stays within the first year of diagnosis. Patients who died within the first year were excluded.

This led to inclusion of over 16k patients over the 5-year entry period (2019 to 2023 inclusive). Of these, just under 6k had been exposed to at least 2 sessions of acupuncture in the year following diagnosis. 1:1 PSM reduced the number to 4 315 in each of the exposed and non-exposed cohorts.

As we have seen before, PSM generally uses age, sex, residential area, income, CCI, and comorbidities, but this time there was a new (for me) factor called the CHA₂DS₂-VASc score. This score was designed to predict stroke in patients with AF, but it also predicts vascular dysfunction and cardiovascular events in high-risk patients without clinical AF.[2] This score was calculated from 1 year prior to entry into the study and used to stratify the cohorts for matching.

The score is calculated based on the following criteria:

C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A₂: Age ≥75 years (2 points)
D: Diabetes mellitus (1 point)
S₂: Stroke or transient ischemic attack history (2 points)
V: Vascular disease (1 point)
A: Age 65-74 years (1 point)
Sc: Sex category (female) (1 point)

The total score ranges from 0 to 9 points, with higher scores indicating a higher risk of stroke or (as in this case) cardiovascular or all-cause mortality.

For your interest and not directly relevant to this particular paper, there is a modification of this score to include a further 2 points in the presence of reduced renal function (eGFR <60ml/min/1.73m²). The acronym becomes R₂CHA₂DS₂-VASc.

In the acupuncture cohort, cardiovascular mortality was significantly lower (aHR 0.79) and all-cause mortality was slightly lower still (aHR 0.73), which was very highly statistically significant.

Further analysis based on acupuncture exposure revealed that those patients receiving 17 or more sessions in the year following diagnosis had an even more impressive reduction in risk – cardiovascular mortality aHR 0.47, all-cause mortality aHR 0.57. I was surprised to see that there were over a thousand patients in this subgroup.

A sensitivity analysis was performed that is also relevant to acupuncture exposure. In this analysis, patients in the non-acupuncture cohort were excluded if they had received any acupuncture at all, even after the first year. This brought the cohort sizes down to 1 857 after PSM. The risk reduction was again more impressive than the primary analysis – cardiovascular mortality aHR 0.47, all-cause mortality aHR 0.43.

The risk dropped even further when the subgroup with the highest acupuncture exposure were identified from within the sensitivity analysis – cardiovascular mortality aHR 0.29, all-cause mortality aHR 0.34.

References

1          Jun H, Jin H, Kim H, et al. Association between acupuncture treatment exposure and mortality in patients with heart failure: a nationwide cohort study. Front Cardiovasc Med. 2025;12:1461302. doi: 10.3389/fcvm.2025.1461302

2          D’Errico MM, Piscitelli P, Mirijello A, et al. CHA2DS2-VASc and R2CHA2DS2-VASc scores predict mortality in high cardiovascular risk population. Eur J Clin Invest. 2022;52:e13830. doi: 10.1111/eci.13830

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Declaration of interests MC