Continuation of Tolvaptan after Discharge is Associated with an Improved Long-Term Prognosis and a Reduction in Number of Readmissions in Patients with Chronic Heart Failure

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  • トルバプタンの外来継続はうっ血性心不全患者の長期予後改善と，心不全による再入院回数の減少に関連する

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Objective : The efficacy of long-term use of tolvaptan after discharge for chronic heart failure (HF) is unclear. The purpose of this study is to clarify the efficacy of long-term use of tolvaptan after discharge from in-hospital admission due to decompensated HF. Methods and Patients or / Materials : We retrospectively analyzed 407 consecutive patients with decompensated HF requiring in-hospital care and their one-year outcomes after discharge. After excluding the 42 patients with in-hospital death or dialysis, 365 patients were investigated. / Results : A multivariable analysis indicated that admission due to decompensated HF at least once in the past year before the index admission (defined as amfrequent flyern), higher age, a low hemoglobin level, male gender and receiving noninvasive positive pressure ventilation (NPPV) were associated with HF readmissions. We compared HF readmissions rate and a composite endpoint (HF readmissions plus all cause death) rate between the group of continued tolvaptan after discharge and the other group of patients. A propensity matching method was utilized to compare the group of continued tolvaptan (n=37) with the group of others (n=37). The rate of freedom from HF readmissions one year after discharge was tended to be higher in the group of continued tolvaptan than the group of others (p=0.08). The rate of freedom from the composite endpoint (HF readmissions and all-cause death) was higher in the group of continued tolvaptan than the group of others (p=0.04). Change in number of HF admissions one-year before and after the index admission was greater in the group of continued tolvaptan than in the group of others (-1.78±1.05 vs. -1.08 ±0.82, p=0.002). The same results were obtained in analyzing 59 frequent flyer patients (-2.31 ± 1.08 vs. -1.43 ± 0.80, p ＜ 0.001). / Conclusion : These data demonstrated that continuation of tolvaptan after discharge is associated with an improved long-term prognosis and a reduction in number of HF readmissions, suggesting a long-term benefit of tolvaptan in patients with chronic heart failure.

Journal

  • 福岡醫學雜誌

    福岡醫學雜誌 111 (1), 43-55, 2020-03-25

    Fukuoka Medical Association

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