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

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

doi:10.1186/s12872-022-02640-7

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

BMC Cardiovasc Disord. 2022 Apr 29;22(1):202. doi: 10.1186/s12872-022-02640-7.

Authors

Shunsuke Kiuchi¹, Shinji Hisatake², Takayuki Kabuki², Takashi Oka², Shintaro Dobashi², Yoshiki Murakami², Takahide Sano², Takanori Ikeda²

Affiliations

¹ Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan. syunnsuke@med.toho-u.ac.jp.
² Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.

Abstract

Background: Elderly patients with heart failure (HF) have been observed to decrease activities of daily living (ADL) during hospitalization. Prevention of ADL decline from shortening of hospital stays is especially important in the elderly, because decreasing ADL is associated with poor prognosis. We investigated the relationship between the early initiation of tolvaptan (TLV) after hospitalization and the length of hospital stay in patients with HF aged younger than 80 years and aged 80 years and older.

Methods: We analyzed 146 patients younger than 80 years (< 80) and 101 patients aged 80 years and older (≥ 80) who were hospitalized with HF from February 2011 to June 2016 and had initiated TLV. The relationship between the time until commencement of TLV and the length of hospital stay was assessed. Additionally, a comparison made between the TLV early start group (within the median) and the delayed start group (over the median) for both groups. Multivariate analysis was also performed on factors that required hospital stays below the median.

Results: A significant correlation was observed between time to TLV initiation and the length of hospital stay (< 80: r = 0.382, P < 0.001; ≥ 80: r = 0.395, P < 0.001). The length of hospital stay in the early group was significantly longer than that in the delayed group for both groups (< 80: early 21.0 ± 13.0 days and 33.0 ± 22.7 days, respectively, P < 0.001; ≥ 80: early 21.3 ± 12.5 days and 32.9 ± 17.9 days, respectively, P < 0.001). Conversely, no statistically significant difference found in the length of hospital stay after initiation of TLV. Moreover, no increase in adverse events in the elderly observed. A multivariate analysis revealed that a predictive factor for short-term hospitalization was early administration of TLV regardless of age.

Conclusions: The early initiation of TLV after hospitalization was associated with a shorter length of hospital stay in patients with HF regardless of age.

Keywords: Elderly; Heart failure; The Length of hospital stay; Tolvaptan.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Antidiuretic Hormone Receptor Antagonists* / adverse effects
Heart Failure* / complications
Heart Failure* / diagnosis
Heart Failure* / drug therapy
Humans
Patient Discharge
Tolvaptan / adverse effects

Substances

Antidiuretic Hormone Receptor Antagonists
Tolvaptan