Tolvaptan response predictors in acute heart failure patients with congestion

HF (heart failure) is associated with significant mortality, morbidity, and health expenditure. HF prevalence in the Indonesian population is 5%, which is higher than Asia as a whole, Europe, and the US. The mortality rate for HF in Southeast Asia is approximately 13%. Diuretics are used in HF patients to treat dyspnea and edema in those with symptoms and signs of congestion as manifested by excess body fluid. The most widely used diuretics are loop diuretics such as furosemide. Tolvaptan, a V2 (vasopressin 2) receptor antagonist, has been used in many countries as an adjunct to diuretic therapy for HF. In the US, tolvaptan is indicated for hypervolemic or euvolemic hyponatremic patients, including those with acute HF. In Asian countries, including Indonesia, tolvaptan can also be used in normonatremic HF patients who have volume overload and do not respond to conventional diuretics. Various clinical trials and retrospective studies have demonstrated the efficacy and safety of tolvaptan. The EVEREST clinical trial of tolvaptan showed survival rates were not superior to those in the placebo group, but survival rate was shown to increase in hyponatremic patients. Therefore, there are indications that the optimal effect of tolvaptan can be achieved by use in specific populations. The identification of responders to and predictors for tolvaptan use are consequently important for developing individual treatment plans. In addition, the use of tolvaptan is still hampered by its relatively high price. National insurance in Indonesia does not cover tolvaptan, thus, health professionals need a strategy for