ESC Heart Failure (Oct 2023)

The characteristics and outcomes in patients with acute heart failure who used tolvaptan: from KCHF registry

  • Ryusuke Nishikawa,
  • Takao Kato,
  • Takeshi Morimoto,
  • Hidenori Yaku,
  • Yasutaka Inuzuka,
  • Yodo Tamaki,
  • Erika Yamamoto,
  • Neiko Ozasa,
  • Tomohisa Tada,
  • Hiroki Sakamoto,
  • Yuta Seko,
  • Masayuki Shiba,
  • Yusuke Yoshikawa,
  • Yugo Yamashita,
  • Takeshi Kitai,
  • Ryoji Taniguchi,
  • Moritake Iguchi,
  • Kazuya Nagao,
  • Takafumi Kawai,
  • Akihiro Komasa,
  • Yuichi Kawase,
  • Takashi Morinaga,
  • Mamoru Toyofuku,
  • Yutaka Furukawa,
  • Kenji Ando,
  • Kazushige Kadota,
  • Yukihito Sato,
  • Koichiro Kuwahara,
  • Takeshi Kimura,
  • for the KCHF Study Investigators

DOI
https://doi.org/10.1002/ehf2.14494
Journal volume & issue
Vol. 10, no. 5
pp. 3141 – 3151

Abstract

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Abstract Aims The use of tolvaptan is increasing in clinical practice in Japan. However, the characteristics of patients who used tolvaptan and the timing of its use in patients with acute heart failure (AHF) are not fully elucidated. Methods and results Among consecutive 4056 patients in the Kyoto Congestive Heart Failure registry, we analysed 3802 patients after excluding patients on dialysis, prior or unknown tolvaptan use at admission, and unknown timing of tolvaptan use, and we divided them into two groups: tolvaptan use (N = 773) and no tolvaptan use (N = 3029). The prevalence of tolvaptan use varied widely from 48.7% to 0% across the participating centres. Factors independently associated with tolvaptan use were diabetes, poor medical adherence, oedema, pleural effusion, hyponatraemia, estimated glomerular filtration rate < 30 mL/min/1.73 m2, moderate/severe tricuspid regurgitation, dobutamine infusion within 24 h, and additional inotropes infusion beyond 24 h after admission. The mortality rate at 90 days after admission was significantly higher in the tolvaptan use group than in the no tolvaptan use group (14.3% vs. 8.6%, P = 0.049). However, after adjustment, the excess mortality risk of tolvaptan use relative to no tolvaptan use was no longer significant (hazard ratio = 1.53, 95% confidence interval = 0.77–3.02, P = 0.22). Patients with tolvaptan use had a longer hospital stay [median (interquartile range): 22 (15–34) days vs. 15 (11–21) days, P < 0.0001] and a higher prevalence of worsening renal failure (47.0% vs. 31.8%, P < 0.0001) and worsening heart failure (24.8% vs. 14.4%, P < 0.0001) than those without. Conclusions AHF patients with tolvaptan use had more congestive status with poorer in‐hospital outcomes and higher short‐term mortality than those without tolvaptan use. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).

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