Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Sato, Yusuke; Uzui, Hiroyasu; Mukai, Moe; Shiomi, Yuichiro; Hasegawa, Kanae; Ikeda, Hiroyuki; Takahashi, Naoto; Fukuoka, Yoshitomo; Morishita, Tetsuji; Ishida, Kentaro; Kaseno, Kenichi; Miyazaki, Shinsuke; Nakano, Akira; Tada, Hiroshi

doi:10.1177/1074248419861962

Cited by 5 publications

(11 citation statements)

References 31 publications

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“…HF was categorized as ‘HF preserved ejection fraction’ (HFpEF) (left ventricular ejection fraction [LVEF] ≥ 50%), ‘HF mildly reduced EF’ (HFmrEF) (LVEF 40–49%), and ‘HF reduced EF’ (HFrEF) (LVEF <40%) 1 . The doses of 60 mg azosemide and 10‐mg torasemide were equivalent to 40 mg furosemide 7 . The D2F time was defined as the time from arrival of a patient at a participating hospital to the first administration of furosemide 4 …”

Section: Methodsmentioning

confidence: 99%

“…In Japan, this drug has been used, together with loop diuretics, in volume overload HF patients since 2010 5 . 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%

“…5 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][9][10] Regarding time-sensitive treatment of AHF, door-to-furosemide (D2F) time has been reported to affect clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…In recent years, TLV has been used as one of the therapeutic agents for HF patients with volume overload along with loop diuretics in Japan. The efficacy and safety of TLV in elderly patients with HF have been reported in the Surveillance In Heart faiLurE (SMILE) study and other previous studies [10][11][12][13]. However, few studies have investigated the outcomes of elderly patients treated with TLV during the hyperacute phase of HF.…”

Section: Introductionmentioning

confidence: 96%

Prognostic Impact of the Early Use of Tolvaptan in Elderly Patients with Acute Decompensated Heart Failure

Okada

Miyoshi

Oka

et al. 2023

JCM

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The number of elderly patients with acute decompensated heart failure (ADHF) is increasing, and it is often difficult to treat. This study aimed to evaluate the efficacy and safety of using tolvaptan early after hospitalization in elderly patients with ADHF and the prognosis one year after hospitalization. This study enrolled 185 patients with ADHF who were admitted for the first time. Tolvaptan was administered within 24 h after admission. These patients were assigned to two groups: over 80 years old (n = 109) and under 80 years old (n = 76). There were no significant differences between the two groups in the occurrence of MACCE within one year (25% vs. 20%, p = 0.59). All-cause mortality was significantly higher in the over-80 group (12% vs. 2%, p = 0.01). There were no significant differences in the incidence of worsening renal failure (11% vs. 7%, p = 0.46) and hypernatremia (5% vs. 9%, p = 1.0), and in the duration of hospitalization (19.2 days vs. 18.8 days, p = 0.8). Tolvaptan might be effective and safe in elderly patients with ADHF, and there was no difference in the incidence of MACCE within one year.

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“…TLV combined with loop diuretics has been shown to be effective in the treatment of diuretic-resistant AHF patients ( 6 , 15 , 16 ). However, there are few reports on whether TLV is equally effective in elderly patients with AHF and oliguria ( 10 , 17 ). For this reason, in this study, we examined the efficacy and safety of TLV in elderly patients with AHF and oliguria.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of tolvaptan on the short and mid-term prognosis in elderly patients with acute heart failure coexisting with oliguria: A retrospective cohort study

Liu

Zhang

Chen

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn patients with acute heart failure (AHF) coexisting with oliguria, high doses of loop diuretics are often ineffective in increasing urine output and may adversely affect the patient's prognosis, especially in elderly patients. We investigated the efficacy of adding tolvaptan (TLV) on improving the prognosis in elderly patients with AHF coexisting with oliguria.MethodsAll data for this retrospective cohort study were extracted from the electronic medical record system of the Second Medical Center of Chinese PLA General Hospital from January 2018 to December 2020. Patients diagnosed with AHF coexisting with oliguria were enrolled in this study and were divided into TLV and non-TLV groups based on the use of TLV. The primary outcome was all-cause mortality at 7 and 90-day. The secondary outcomes were the remission of AHF within 7 and 30 days or continued progression of AHF, and new-onset chronic kidney disease (CKD) after 90 days. Cox proportional hazards regression was used to assess the relationships between all-cause mortality and diuretic regimens, demographics, laboratory parameters, comorbidities, and medications.ResultsA total of 308 patients met the study criteria for the final statistical analysis, and they had a median age of 91 years (88, 95). The results showed that the addition of TLV was associated with a decreased risk of the 7 and 90-day all-cause mortality in patients with AHF with oliguria [adjusted HR, 95% CI: 0.60 (0.37, 0.98), p = 0.042; 0.56 (0.41, 0.75), p < 0.001, respectively]. Adding TLV significantly increased urine output and decreased N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in 7 days, and alleviated the progression of AHF within 30 days. There were no statistically significant differences between the patients with or without TLV in terms of the occurrence of hypernatremia, the development of hepatic impairment within 30 days, and new-onset CKD after 90 days.ConclusionsThis study demonstrated that the addition of TLV was clinically effective in increasing urine output, and had favorable effects on alleviating AHF progression and may reduce the risk of all-cause mortality at 7 and 90-day in elderly patients with AHF with oliguria, and TLV had a good safety profile.Trial registrationhttp://www.chictr.org.cn/showprojen.aspx?proj=148046, identifier: ChiCTR2200055518.

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Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Cited by 5 publications

References 31 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

Prognostic Impact of the Early Use of Tolvaptan in Elderly Patients with Acute Decompensated Heart Failure

Efficacy of tolvaptan on the short and mid-term prognosis in elderly patients with acute heart failure coexisting with oliguria: A retrospective cohort study

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