Predictors of Tolvaptan Response as a Therapy Optimization Strategy in Heart Failure Patients: A Narrative Review

Heart failure (HF) is an end-stage condition of all heart disease and is associated with significant mortality, morbidity, and health expenses. Tolvaptan, a V2 receptor antagonist, is being used in many countries as an adjunct to the diuretic therapy of HF. Although it has been proven effective and safe, some patients do not respond well to the medication. Since there are indications that a specific population can achieve this therapy’s optimal effect, it is essential to identify responders and predictors to develop individual treatment plans. Therefore, this study provides an overview of the effect of tolvaptan and predictors of response that can be used as a strategy in optimizing the treatment of HF. The article searching process was conducted through PubMed, Google Scholar, and Scopus, including predictors, heart failure, and tolvaptan. The predictors identified in the study were urine osmolality, U-AQP2/PAVP, age, serum creatinine, BUN, BUN/Cr, UUN/BUN, UNa/UCr, BNP, AVP/PAC, CKD, HFpEF, and echocardiographic parameters. The variation in results is caused by differences in response definition, patient characteristics, and the types of variables analyzed. Implementing some of these predictors in countries with inadequate hospital facilities and health insurance coverage is complicated. Therefore, the use of response predictors, at any rate, is expected to assist health professionals in considering the risks and benefits of HF therapy.