157 - Treatment Length of Stay for Chronic Heart Failure Patients in a Hyponatremia Registry Patients in a Hyponatremia Registry

Abstract

Introduction: Hyponatremia (HN) is a prevalent electrolyte disorder in patients hospitalized with congestive heart failure (CHF). Treatment options include fluid restriction or vasopressin receptor antagonists such as tolvaptan. Hypothesis: Compared to other therapies used to treat hyponatremia in hospitalized CHF patients, tolvaptan will result in shorter time to resolution of HN and a higher proportion of patients with improved resolution of HN (serum sodium > 130 mEq/L). Methods: The Hyponatremia Registry was a prospective, multicenter, multinational study of hospitalized patients with euvolemic and hypervolemic HN. Patients with a serum sodium ≤130 mEq/L were included as these patients were likely to receive treatment to correct low sodium. More than 5,000 patients were enrolled internationally. HN registry patients enrolled in United States hospitals with a primary diagnosis of CHF and treated initially with either fluid restriction or tolvaptan were included. Outcomes included median treatment duration (start of treatment until HN resolution), proportion of patients with HN resolved at discharge or serum sodium >130 mEq/L, and total hospital length of stay. Interquartile ranges are reported for the median values. Two exploratory analyses of the impact of the time from start of treatment to resolution controlling for age, gender and baseline serum sodium and the likelihood of resolved serum sodium were conducted. Results: There are 390 patients treated initially with fluid restriction and 57 patients treated with tolvaptan. Median hospital length of stay was 9 days (6–15 for quartile range) for fluid restriction vs 8 days (6–17 for quartile range) for the tolvaptan group. The median time from hospital admission to start of treatment was 0 days (0–2 days) for fluid restriction and 1 day (0–2 days) for tolvaptan. When evaluating patients with HN resolved at discharge (n = 179 for fluid restriction and 31 for tolvaptan) median hospital length of stay was 10 days (7–17 days) for the fluid restriction group and 8 days (6–18 days) for tolvaptan. For this subgroup of patients, the median treatment duration was 9 days (6–14 days) for fluid restriction compared with 6 days (4–15 days) for tolvaptan. Exploratory analyses indicated shorter treatment duration and HN resolution associated with patients receiving tolvaptan. Conclusions: Patients hospitalized with CHF and HN treated with tolvaptan have shorter length of stay and treatment duration than patients treated with fluid restriction. Patients with CHF and HN waited an additional hospital day before initiating treatment with tolvaptan but had shorter length of stay and were more likely to have a successful HN treatment outcome.