Early initiation of tolvaptan is associated with early discharge in patients with heart failure regardless of age

Kiuchi, Shunsuke; Hisatake, Shinji; Kabuki, Takayuki; Oka, Takahiro; Dobashi, Shintaro; Murakami, Yoshiki; Sano, Takahide; Ikeda, Takanori

doi:10.1186/s12872-022-02640-7

Cited by 4 publications

(11 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have indicated that the early use of tolvaptan within 3 days of hospitalization was associated with a shortened length of hospital stay and improved in‐hospital outcomes 9,10 . On the contrary, our results indicate that early initiation of tolvaptan within 6 h of admission was not related to improved in‐hospital outcomes; moreover, the D2T time did not affect the length of hospital stay in our study ( Figure ).…”

Section: Discussioncontrasting

confidence: 82%

“…Over the past few years, several studies have been conducted to investigate the favourable effects of tolvaptan on clinical outcomes in HF patients under various situations 6,7 . Early initiation of tolvaptan, within a couple of days, provided immediate decongestion and better clinical outcomes, such as prevention of worsening renal function (WRF) and shortening of the length of hospital stay 8–10 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of door‐to‐tolvaptan time on short‐term clinical outcome in patients with acute heart failure

Nomura,

Morishita,

Sato

et al. 2023

ESC Heart Failure

View full text Add to dashboard Cite

AimsWe investigated the effects of door‐to‐tolvaptan (D2T) time on short‐term urine volume and in‐hospital clinical outcomes in patients with acute heart failure (AHF).Methods and resultsPatients with AHF, treated with tolvaptan at two hospitals, were enrolled in this retrospective observational study. The D2T time was defined as the time elapsed from the arrival of a patient at a participating hospital to the first administration of tolvaptan. The group with the D2T time within 6 h was defined as the ‘early group’. The primary outcome was 48‐h urine volume. The secondary outcomes were in‐hospital death, length of hospital stay, and worsening renal function (WRF) incidence. A restricted cubic spline model was used to evaluate the presence of a nonlinear association between the D2T time and 48‐h urine volume and the odds ratio of WRF incidence. Our study included a total of 138 patients with AHF who were started on tolvaptan after hospitalization. The median D2T time was 5.3 h (interquartile range: 3.0–31.9 h). Seventy‐four patients (53.6%) were classified to be in the early group. Baseline characteristics were similar in the two groups: mean age (85.4 ± 9.6 years vs. 84.5 ± 9.5 years; P = 0.59) and male sex (n = 22 [33.3%] vs. n = 29 [46%]; P = 0.16), except that patients in the early group had higher systolic blood pressure than those in the delayed group (138.2 ± 22.9 vs. 125.7 ± 21.7; P = 0.001). The initial tolvaptan dose in the delayed group was much lower than that in the early group (7.5 [7.5, 7.5] vs. 7.5 [5.6, 7.5] mg; P = 0.01). Total urine volume in 48 h did not differ in the early and delayed groups (4113 ± 1758 mL vs. 4201 ± 1893 mL; P = 0.80). The relationship between D2T time and total urine volume within 48 h increased slightly, with a peak at a D2T time of 15 h, and gradually decreased, thereafter. In‐hospital death and the length of hospital stay did not differ significantly between the two groups (n = 1, 1.3% vs. n = 4, 6.3%; P = 0.18, and 5.0 [12.0, 30.0] vs. 22.0 [14.5, 30.0] days; P = 0.17, respectively). Notably, the restricted cubic spline model for the odds ratio of WRF incidence increased as the D2T time was delayed (P for effect<0.01).ConclusionsThe shorter D2T time did not affect the short‐term urine volume and in‐hospital outcomes but reduced the risk of WRF incidence in patients with AHF.

show abstract

Section: Discussioncontrasting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Effects of door‐to‐tolvaptan time on short‐term clinical outcome in patients with acute heart failure

Nomura,

Morishita,

Sato

et al. 2023

ESC Heart Failure

View full text Add to dashboard Cite

show abstract

“…The EF was calculated using either the modified Simpson method (apical two‐ or four‐chamber view) or the Teichholz method (parasternal long‐axis view) 15 . Furthermore, the proportion of patients with HFpEF was also evaluated 16 . HFpEF was defined as EF > 50% according to the guidelines from the Japan Circulation Society, the American Heart Association, and the European Society of Cardiology 17–19 …”

Section: Methodsmentioning

confidence: 99%

“…15 Furthermore, the proportion of patients with HFpEF was also evaluated. 16 HFpEF was defined as EF > 50% according to the guidelines from the Japan Circulation Society, the American Heart Association, and the European Society of Cardiology. [17][18][19] VaSera VS-1500E (Fukuda Denshi Company, Ltd.) was used to measure the ABI and CAVI after 12 h of fasting in the morning following ADHF improvement.…”

Section: Physiological Functional Examinationsmentioning

confidence: 99%

Importance of anemia in heart failure over blood pressure variability

Kiuchi,

Hisatake,

Kabuki

et al. 2023

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

BackgroundThe evaluation of arteriosclerosis (vascular function) is important when treating heart failure (HF). Vascular dysfunction is associated with anemia through renal function and endothelial nitric oxide synthase. Additionally, blood pressure (BP) variability (BPV) caused by vascular dysfunction is also associated with HF prognosis. However, how anemia and BPV may affect HF prognosis is unclear.MethodsBetween January 2012 and July 2018, 214 patients with HF were hospitalized. The cardio‐ankle vascular index (CAVI) as an index of arteriosclerosis of these patients was measured. The patients were divided into the elevated and preserved CAVI groups. We investigated the factors related to major adverse cardiovascular events (MACEs) as cardiovascular death or rehospitalization within 1 year after discharge.ResultsIn the elevated CAVI group, significant differences in body mass index (BMI), BPV, left ventricular dimension, and hemoglobin levels were observed between patients with and without MACEs. In the preserved CAVI group, significant differences in BMI, diastolic/mean BP, and hemoglobin levels were observed between those with and without MACEs. The multivariate analysis showed an independent association between hemoglobin levels and MACE occurrence in both the elevated and preserved CAVI groups (elevated CAVI group: hazard ratio [HR] = 0.800, p = .045 [model 1], HR = 0.802, p = .035 [model 2]; preserved CAVI group: HR = 0.783, p = .049 [model 1], HR = 0.752, p = .023 [model 2], and HR = 0.754, p = .024 [model 3]).ConclusionsAnemia was independently associated with HF prognosis with or without arteriosclerosis.

show abstract

“…We calculated the EF using either the modi ed Simpson method (apical two-or four-chamber view) or the Teichholz method (parasternal long-axis view) [16]. The proportion of patients with HFpEF was also evaluated [17]. HFpEF was de ned as EF > 50% according to some guidelines from the Japan Circulation Society, the American Heart Association, and the European Society of Cardiology [18,19,20].…”

Section: Physiological Functional Examinationsmentioning

confidence: 99%

Importance of Anemia in Heart Failure over Blood Pressure Variability

Kiuchi

Hisatake

Kabuki

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

The evaluation of arteriosclerosis (vascular function) is important when treating heart failure (HF). Vascular dysfunction is associated with anemia through renal function and endothelial nitric oxide synthase, and many patients with HF have anemia. Additionally, blood pressure variability (BPV) caused by vascular dysfunction is also associated with HF prognosis. However, how anemia and BPV may affect HF prognosis is unclear. Between January 2012 and July 2018, 214 patients with HF were hospitalized, the cardio-ankle vascular index (CAVI) as an index of arteriosclerosis of whom was measured. According to the CAVI, the patients were divided into the elevated and preserved CAVI groups. Furthermore, we investigated the factors related to major adverse cardiovascular events (MACE). MACE was defined as cardiovascular death or rehospitalization within 1 year after discharge. In the elevated CAVI group, significant differences in body mass index (BMI), BPV, left ventricular dimension, and hemoglobin levels were observed between patients with MACE and those without MACE. Meanwhile, in the preserved CAVI group, significant differences in BMI, diastolic/mean blood pressure values, and hemoglobin levels were observed. The multivariate analysis showed an independent association between hemoglobin level and MACE occurrence in both the elevated and preserved CAVI groups (elevated CAVI group: hazard ratio [HR] = 0.800, P = 0.045; preserved CAVI group: HR = 0.783, P = 0.049 {model 1}, and HR = 0.752, P = 0.023 {model 2}). Anemia was independently associated with HF prognosis with or without arteriosclerosis. In HF with arteriosclerosis, BPV may also be useful for evaluating the prognosis.

show abstract

Early initiation of tolvaptan is associated with early discharge in patients with heart failure regardless of age

Cited by 4 publications

References 30 publications

Effects of door‐to‐tolvaptan time on short‐term clinical outcome in patients with acute heart failure

Effects of door‐to‐tolvaptan time on short‐term clinical outcome in patients with acute heart failure

Importance of anemia in heart failure over blood pressure variability

Importance of Anemia in Heart Failure over Blood Pressure Variability

Contact Info

Product

Resources

About