Evidence map›Paper›PMID 28523370›Full record

SynthesisHerz2018

Use of tolvaptan vs. furosemide in older patients with heart failure : Meta-analysis of randomized controlled trials.

W-L Huang, Y Yang, J Yang, J Yang, H-B Wang, X-L Xiong, Y-F Zhang

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Herz, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 3 pooled it
1.1field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 3 syntheses or guidelines pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. Management of Acute Heart Failure during an Early Phase.International journal of heart failure · 2020
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

W-L HuangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China.
Y YangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China.
J YangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China. yangjun@ctgu.edu.cn.
J YangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China. yangjian@ctgu.edu.cn.
H-B WangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China.
X-L XiongInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China.
Y-F ZhangInstitute of Cardiovascular Diseases, the First College of Clinical Medical Sciences, China Three Gorges University, 443000, Yichang, Hubei Province, China.
China Three Gorges University · CN

Funding

National Natural Science Foundation of China 81470387National Natural Science Foundation of China 81670333
6 · The paper itself

Abstract

backgroundIt 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.

methodsThe 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.

resultsOut 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.

conclusionIn 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.

Indexed as

Antidiuretic Hormone Receptor AntagonistsDiureticsFurosemideHeart FailureTolvaptanAgedBenzazepinesHumansRandomized Controlled Trials as TopicAntidiuretic Hormone Receptor AntagonistsBenzazepinesDiureticsFurosemideTolvaptanAngiotensinAntidiuretic hormone antagonistsHeart decompensationMortalityRenal insufficinecy

Identifiers

PMID28523370
OpenAlexW2615917113

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.