A novel validated method for predicting the risk of re-hospitalization for worsening heart failure and the effectiveness of the diuretic upgrading therapy with tolvaptan

Abstract

Increased re-hospitalization due to acute decompensated heart failure (ADHF) is a modern issue in cardiology. The aim of this study was to investigate risk factors for re-hospitalization due to worsening heart failure, and the effect of tolvaptan (TLV) on decreasing the number of re-hospitalizations. This was a multicenter, retrospective study. The re-hospitalization factors for 1191 patients with ADHF were investigated; patients receiving continuous administration of TLV when they were discharged from the hospital (n = 194) were analyzed separately. Patients were classified into 5 risk groups based on their calculated Preventing Re-hospitalization with TOLvaptan (Pretol) score. The total number of patients re-hospitalized due to worsening heart failure up to one year after discharge from the hospital was 285 (23.9%). Age ≥80 years, duration since discharge from the hospital after previous heart failure <6 months, diabetes mellitus, hemoglobin <10 g/dl, uric acid >7.2 mg/dl, left ventricular ejection fraction (LVEF) <40%, left atrial volume index (LAVI) >44.7 ml/m2, loop diuretic dose ≥20 mg/day, hematocrit <31.6%, and estimated glomerular filtration rate (eGFR) <50 ml/min/1.73m2 were independent risk factors for re-hospitalization for worsening heart failure. There was a significant reduction in the re-hospitalization rate among TLV treated patients in the Risk 3 group and above. In conclusions, age, duration since previous heart failure, diabetes mellitus, hemoglobin, uric acid, LVEF, LAVI, loop diuretic dose, hematocrit, and eGFR were all independent risk factors for re-hospitalization for worsening heart failure. Long-term administration of TLV significantly decreases the rate of re-hospitalization for worsening heart failure in patients with a Pretol score of 7.

Temporal trends of a vasopressin V2 receptor antagonist in heart failure using a nationwide database in Japan

“…Our findings also indicated that the rate of continuing tolvaptan after discharge has been increasing. A recent study suggested the benefits of long‐term tolvaptan treatment in patients with several risk factors for HF readmission 26 . Another retrospective study suggested that long‐term tolvaptan therapy in patients with acute HF and chronic renal failure was safe and reduced the readmission rates due to HF 27 .…”

Evidence for Effective Multiple K+-Current Inhibitions by Tolvaptan, a Non-peptide Antagonist of Vasopressin V2 Receptor

“…Through ionic mechanisms presented herein, it or other structurally similar non-peptide compounds that can be preferentially used for oral intake, is able to influence the functional activities of endocrine or renal tubular cells, if similar findings occur in vivo . Our findings also highlight an important alternative aspect that needs to be taken into account, inasmuch as the aquaretic effects of TLV in different pathologic disorders including polycystic kidney disease, cirrhosis or heart failure, are evaluated (Ghali et al, 2009; Graziani et al, 2012; Mancinelli et al, 2016; Clark et al, 2017; Sweeney and Avner, 2017; (Torres et al, 2017; van Gastel and Torres, 2017; Wu et al, 2017a; Chebib et al, 2018; Edwards et al, 2018; Imamura and Kinugawa, 2018; Matsukawa et al, 2018; McEwan et al, 2018; Müller et al, 2018; Oguro et al, 2018b; Poch et al, 2018; Sen et al, 2018; Takimura et al, 2018).…”

“…Tolvaptan (TLV; Samsca® or Jinarc®) is recognized as an oral aquaretic agent that functions as a selective, competitive antagonist of vasopressin V 2 receptor used to treat hyponatremia associated with congestive heart failure, cirrhosis, or the syndrome of inappropriate antidiuretic hormone (Izumi et al, 2014; Aylwin et al, 2015; Verbalis et al, 2016; Clark et al, 2017; Der-Nigoghossian et al, 2017; Dunlap et al, 2017; Felker et al, 2017; Konstam et al, 2017; Wu et al, 2017a; Berardi et al, 2018; Kogure et al, 2018; Matsukawa et al, 2018; Morris et al, 2018; Oguri et al, 2018a; Sigal et al, 2018; Takimura et al, 2018; Vidic et al, 2019). It was noted to be effective at improving the hyponatremic conditions that may occur in different pathologic conditions including that following pituitary surgery (Izumi et al, 2014; Janneck et al, 2014; Ahluwalia et al, 2015; Aylwin et al, 2015; Ichimura et al, 2015; Gralla et al, 2017; Berardi et al, 2018).…”

Clinical Implications of Uric Acid in Heart Failure: A Comprehensive Review

“…Overall, it seems that SUA could be used as an adjunctive biomarker of poor prognosis in AHF, since its predictive role is independent of traditional prognostic determinants [ 94 ]. In line with this, a recent multicenter study included SUA levels greater than 7.2 mg/dL in the Preventing Re-hospitalization with TOLvaptan (Pretol) score, a novel scoring system that predicts the risk of rehospitalization for worsening heart failure [ 95 ].…”