The effects of tolvaptan dose on cardiac mortality in patients with acute decompensated heart failure after hospital discharge
| Autor: | Yoshio Kawase, Shoichi Ehara, Kenji Matsumoto, Keiko Otsuka, Yasuhiro Nakamura |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure Heart Ventricles Tolvaptan Administration Oral 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Japan Internal medicine Cause of Death medicine Clinical endpoint Humans 030212 general & internal medicine Survival rate Aged Retrospective Studies Aged 80 and over Heart Failure Dose-Response Relationship Drug Proportional hazards model business.industry Hazard ratio Stroke Volume Benzazepines medicine.disease Prognosis Patient Discharge Cardiac surgery Survival Rate Echocardiography Concomitant Acute Disease Female Cardiology and Cardiovascular Medicine business Antidiuretic Hormone Receptor Antagonists medicine.drug Follow-Up Studies |
| Zdroj: | Heart and vessels. 33(10) |
| ISSN: | 1615-2573 |
| Popis: | Tolvaptan (TLV) is a newly developed oral vasopressin-2 receptor antagonist that is mostly used for patients with acute decompensated heart failure (ADHF) refractory to conventional diuretic therapy. The aim of this study was to investigate the effects of outpatient TLV dose on cardiac mortality in patients discharged after hospitalization for ADHF. One hundred and five patients with ADHF who had been treated with TLV for the first time during hospitalization were retrospectively divided into three groups based on outpatient TLV use and dose. The non-TLV group comprised patients who were not treated with TLV after discharge (n = 36). Patients who continued TLV after discharge were further classified into two groups: low-dose (LD)-TLV (3.75 mg/day, n = 27) and high-dose (HD)-TLV (7.5 or 15 mg/day, n = 42). The primary endpoint was cardiac mortality. Secondary endpoint included the composite of all-cause mortality or re-hospitalization due to worsening of ADHF. There were no significant differences in demographic variables other than body mass index (p = 0.0026), echocardiographic data, laboratory data other than serum chloride before TLV administration (p = 0.041), serum sodium (p = 0.040) and potassium (p = 0.027) at discharge, and concomitant medications among the three groups. The Kaplan–Meier curve showed that the survival rate was lower in HD-TLV than in non-TLV, whereas LD-TLV showed the highest survival rate among the three groups (p = 0.0001). Multivariable Cox regression analysis of the clinical characteristics used for predicting cardiac mortality revealed that LD-TLV (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.01–0.93, p = 0.040) and HD-TLV (HR 2.43, 95% CI 1.06–6.26, p = 0.035) were significant predictors after adjustment for predictive covariates. In conclusion, the judgement of the continuation of LD-TLV according to patient hemodynamics and severity of congestion may not cause worsened prognosis. |
| Databáze: | OpenAIRE |
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