Abstract
Few studies have investigated the clinical benefit of the long-term use of tolvaptan (TLV) for heart failure (HF). This study evaluated the long-term prognosis of patients administered TLV for > 1 year among patients who had HF with preserved ejection fraction (HFpEF) and those who had HF with reduced ejection fraction (HFrEF). Overall, 591 consecutive patients were admitted to our hospital and administered TLV for HF between 2011 and 2018. We retrospectively enrolled 147 patients who were administered TLV for > 1 year. We divided them into the HFpEF group (n = 77, 52.4%) and the HFrEF group (n = 70; 47.6%). Their clinical backgrounds and long-term prognosis were examined. Compared with the patients in the HFrEF group, the patients in the HFpEF group were significantly older and included more women. Moreover, the HFpEF group showed significantly lower all-cause mortality (38.6% vs. 24.7%; log-rank, P = 0.014) and cardiovascular mortality during the average 2.7-year follow-up. Univariate analysis revealed that all-cause mortality was correlated with male sex, HFpEF, and changes in serum creatinine levels from baseline. Multivariate analysis revealed that HFpEF was an independent influencing factor for all-cause mortality (hazard ratio, 0.44; 95% confidence interval, 0.23–0.86; P = 0.017). Long-term administration of TLV may be more beneficial for HFpEF than for HFrEF.
Highlights
The prevalence of heart failure (HF) continues to rise in developed countries [1]
At 1 year, compared with the HF with preserved ejection fraction (HFpEF) group, the HF with reduced ejection fraction (HFrEF) group showed a higher rate of initiation of β-blocker drugs and mineralocorticoid receptor antagonist (MRA), which are the standard treatments for HF
The multivariate Cox regression analysis, which adjusted for the significant factors in the univariate Cox regression analysis and age, suggested that HFpEF was the most significant prognostic factor (HR, 0.44; 95% CI, 0.23–0.86; P = 0.017)
Summary
The prevalence of heart failure (HF) continues to rise in developed countries [1]. Japan has one of the highest proportions of aged persons in the world and its population of HF patients is progressively increasing, despite the country’s depopulation. HF is expected to affect 1.32 million patients by 2035 [2]. The high readmission rate for HF is a problem that should be resolved. Past real-world data from Japan in 2015 had indicated that the 1-year mortality of HF was 23% and that the 1-year readmission rate was 26.2% [3]. Compared with patients with no or a single previous HF admission, HF patients with multiple previous HF admissions had a significantly higher risk of all-cause death and HF readmission within 3 years [4].
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