Background and purposeIt is unclear whether nicorandil, a metabolic therapeutic drug, can be applied clinically to therapy of heart failure (HF). This meta-analysis evaluated therapeutic effects of nicorandil on HF patients. Experimental approachWe performed a systematic review and meta-analysis of published studies evaluating effect of nicorandil on HF patients. Studies were stratified according to controlled versus uncontrolled designs and analyzed using random-effects meta-analysis models. Key resultsWe identified a total of 20 studies with a total of 1222 patients. In five randomized controlled studies, nicorandil treatment resulted in reduction in all-cause mortality and hospitalization for cardiac causes (HR: 0.35, P<0.001) and improved cardiac pump function (SMD: 0.31, P=0.02). In 15 observational studies, nicorandil therapy increases cardiac pump function (SMD: 0.75, P<0.001), improves NYHA functional class (WMD: -1.33, P<0.001), decreases PCWP (WMD: -6.86mm Hg, P<0.001), and pulmonary arterial pressure (SMD: -0.84, P<0.001). Conclusions and implicationsThe use of nicorandil in HF patients exerts substantial beneficial effects, suggesting that it may be an additional therapeutic agent for HF.