Use of tolvaptan vs. furosemide in older patients with heart failure: Meta-analysis of randomized controlled trials; [Einsatz von Tolvaptan vs. Furosemid bei älteren Patienten mit Herzinsuffizienz: Metaanalyse randomisierter kontrollierter Studien]

Background: It is not known whether older patients with acute heart failure (HF) receiving tolvaptan have decreased mortality rates and a better long-term prognosis than patients who receive furosemide. We conducted a systematic review of randomized controlled trials (RCTs) to address this issue. Methods: The Medline, Embase, and Cochrane Library databases were searched for English-language RCTs published before September 2016 comparing tolvaptan with furosemide treatment in older patients (>65 years old) after acute HF. The primary outcomes assessed were 6‑month all-cause mortality and worsening renal function (WRF); the secondary outcomes were electrolyte disorders, hospital readmissions, and adverse events. Results: Out of 669 citations, six RCTs met the inclusion criteria for this meta-analysis. There was a significant decrease in WRF (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.52–0.86, p = 0.002) and in the hospitalization period (mean difference [MD] = −1.86, 95% CI = −3.70–−0.02, p = 0.05), as well as a significant increase in urine volume within 3 days of tolvaptan administration (MD = 1.59, 95% CI = 1.41–1.76, p < 0.00001). There were significant differences in creatinine levels between subgroups (MD = 0.33, 95% CI = 0.14–0.52, p = 0.0006). However, for the outcome of 6‑month all-cause mortality (RR = 0.56, 95% CI = 0.29–1.06, p = 0.07), there was no significant difference among all subgroups. There were significant differences in serum sodium concentration (MD = 0.68, 95% CI = 0.02–1.34, p = 0.04) but no significant changes in systolic blood pressure (MD = 3.57, 95% CI = −2.33–9.47, p = 0.24) between groups. Conclusion: In older patients, tolvaptan relieves WRF, reduces the hospitalization period, and increases urine volume without significant effects on blood pressure. However, surprisingly, the use of tolvaptan did not influence 6‑month all-cause mortality. © 2017, Springer Medizin Verlag GmbH.