Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: A meta-analysis

Abstract

Considering the prevalence of dyspnea in acute heart failure (AHF), its reduction is important to both patients and caregivers. This meta-analysis was performed to determine the efficacy and safety of tolvaptan on early dyspnea relief in patients with AHF. A systematic search was made of PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of AHF with tolvaptan, compared with placebo or blank, were reviewed. Studies were pooled to relative risk (RR), with 95% confidence interval (CI). Five RCTs (enrolling 4857 participants) met the inclusion criteria. Tolvaptan presented significant effects on 12 h dyspnea relief (RR: 1.98; 95% CI: 1.24-3.15; p = .004), 24 h/day 1 dyspnea relief (RR: 1.15; 95% CI: 1.07-1.24; p = .0003), 48 h dyspnea relief (RR: 1.20; 95% CI: 1.06-1.36; p = .004), and 72 h dyspnea relief (RR: 1.18; 95% CI: 1.02-1.37; p = .03). No significant increase was noticed in the incidence of worsening renal function in tolvaptan group (RR: 1.10; 95% CI: 0.87-1.39; p = .43). Tolvaptan treatment significantly improved patient-assessed dyspnea early and persistently in patients with AHF.

Keywords: acute heart failure; early dyspnea relief; meta-analysis; tolvaptan; worsening renal function.

Figure 1

Flow chart for selection of studies. RCTs, randomized controlled trials.

Figure 2

Effects of tolvaptan on patient‐assessed dyspnea at (A) 8, (B) 12, (C) 24 h or day 1, (D) 48, and (E) 72 h. CI, confidence interval, M−H, Mantel−Haenszel.

Figure 3

Effects of tolvaptan on the incidence of worsening renal function.