Psychological Issues in Heart Failure Patients Who Received Implantable Cardioverter-Defibrillator

Abstract

Background: Symptomatic patients with severe aortic stenosis (AS) are usually are operative candidates because medical therapy has little to offer. Tolvaptan (TLV) treatment resulted in favorable but modest changes in filling pressures associated with a significant increase inurine output. Therefore,TLVisapotential candidate to improvedecompensated heart failure due to severe AS without hemodynamic instability.Methods: We retrospectively investigated 5 patients over 80 years of age who admitted due to decompensated congestive heart failure with severe AS and treated with tolvaptan from April 2014 to March 2015. Results: Four females and a male were examined. Mean age was 90.666.6 years. Compared to total urine volume of the day before treatment, those of the first day were increased (9286478 vs. 12036517 ml, P50.03). Urine osmolality tended to be increased in the first day of treatment (4086137 vs. 2616155 mOsm, P50.06). NYHA classification was significantly improved 1 week after treatment (3.860.4 vs. 3.060.0, P50.02). BNP levels were decreased 1 week after TLV treatment and at discharge (12646796 vs. 6356470 pg/mL, P50.03, vs. 5386343 pg/mL, P50.03, respectively). Severe adverse events, including death, cardiogenic shock did not occur during TLV treatment. Conclusions: TLV treatment safely improved decompensated heart failure due to AS in old patients. Further prospective studies are warranted to confirm these results.