Tolvaptan in reversing worsening acute heart failure: A systematic review and meta-analysis.

Objective In this meta-analysis, we aimed to compare efficacy and clinical outcomes of tolvaptan in treating acute heart failure (AHF). Methods Using MEDLINE, we searched relevant clinical studies using tolvaptan that investigated clinical effects in treating AHF. We performed meta-analysis for potentially extractable clinical outcomes such as body weight reduction, change in serum sodium levels, and clinical or safety events including worsening heart failure, worsening renal function (WRF), all-cause mortality, rehospitalization, and dyspnea improvement. Results The results showed that tolvaptan significantly reduced body weight (mean change: -1.28 kg, 95% credible interval (CI): -1.58-0.98), increased serum sodium levels (mean change: 3.48 mmol/L; 95% Cl: 3.22-3.74), and improved dyspnea function (odds ratio (OR): 1.43; 95% CI: 1.26-1.62) versus conventional therapy. The event risk of WRF was also significantly reduced (OR: 0.35; 95% CI: 0.15-0.80). Low, intermediate, and high tolvaptan doses did not reduce mortality and rehospitalization risks. No significant publication bias was observed regarding effects on mortality and rehospitalization. Conclusion Current evidence indicates that using tolvaptan as add-on therapy can decrease body weight, increase sodium levels, improve dyspnea function, and reverse WRF, which may circumvent loop diuretics overdose and improve outcomes in patients with AHF.