Abstract 11788: Tolvaptan Add-On Therapy on Efficacy Parameters and Outcomes in Patients Hospitalized With Acute Heart Failure

Abstract

Introduction: Even with the adequate use of diuretics and vasodilators, volume overload and congestion are the major causes of morbidity and mortality in patients hospitalized with acute heart failure (HF). Hypothesis: We aim to evaluate the additive effect of tolvaptan on efficacy parameters as well as outcomes in hospitalized patients with HF. Methods: We searched PubMed, EMBASE, Cochrane library, and Web of Science databases for randomized controlled trials that studied the effects of tolvaptan versus placebo in hospitalized patients with HF. Studies were included if they had any of the following endpoints: mortality, re-hospitalization, and in-hospital parameters like dyspnea relief, change in weight, sodium, and creatinine. Results: The meta-analysis analyzed data from 14 studies involving 5945 patients. The follow up duration ranged from 30 days to 2 years. Between tolvaptan and placebo groups, there was no difference in mortality [relative risk (RR) 0.73 (0.46, 1.18) p =0.2] and rehospitalization [RR 0.79 (0.51, 1.22) p = 0.28]. HF patients had a better dyspnea relief score (Likert score) in tolvaptan group [RR 1.19 (1.06, 1.33) p = 0.003] and mean reduction in weight in the first 48 hours (short-term) [mean difference (MD) -2.19 (-.35, -0.86) p = 0.001]. However, at 7 days (medium-term) the mean difference in weight was not significant [MD -0.67 (-1.45, 0.11) p = 0.09]. Serum sodium increased significantly in tolvaptan group [MD 3.75 (2.92, 4.58) p < 0.00001]. There was no difference in creatinine [MD 0.00 (-0.08, 0.08) p = 0.98] among the two groups. (Figure 1) Conclusions: Our meta-analysis shows that during hospitalization of HF patients, tolvaptan can be useful in short-term symptomatic dyspnea relief and initial reduction in weight due to its additive diuretic effect. However, this benefit is short-lived and there is no advantage in reducing rehospitalization rates and mortality. Further, tolvaptan is not effective for sustained and long term weight loss.