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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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| Abstract | 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 aft...er 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. 目的：慢性心不全に対するトルバプタンの退院後の長期使用の効果は明らかではなく，この研究ではその効果についての検討を行った． 方法：我々は連続407 名の入院を必要とするうっ血性心不全患者の退院後1 年間の予後について検討，42 名の院内死亡，透析患者を除いた365 名について解析を行った．結果：多変量解析を行うと，入院前1 年間に少なくとも1 回以上の心不全入院歴のある患者（frequent flyer と定義），高齢であること，貧血があること，男性であること，NPPVによる治療を受けた ことなどが1 年間の心不全再入院と関連が強い因子として残った．我々は続いて退院後にトルバプタンを継続したことと心不全再入院についての関連について調べた．トルバプタン継続群とそれ以外で，心不全再入院と関連する交絡因子を含めた背景を揃えるためにプロペンシティマッチングを行い，それぞれ37 名ずつでの解析を行った．1 年間の心不全再入院回避率はトルバプタン継続群で高い傾向にあった（p=0.08）．心不全再入院回避率と全死亡回避率を合わせた複合アウトカムはトルバプタン継続群で有意に高かった（p=0.04）．さらに，対象入院前の1 年間の心不全入院回数と退院後1 年間の再入院回数の変化を比べたところトルバプタン継続群で入院回数の減少率は有意に高かった（-1.78 ± 1.05 vs. -1.08 ± 0.82, p=0.002）．さらに，59 名のfrequent flyer の患者だけで比べても同様の結果が得られた(-2.31± 1.08 vs. -1.43±0.80，p ＜0.001）． 結論：これらの結果から退院後のトルバプタン継続はうっ血性心不全患者の長期予後を改善し，心不全再入院回数を減少させる可能性が示唆された．show more |
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| Created Date | 2020.06.18 |
| Modified Date | 2023.11.15 |