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Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure [Anatol J Cardiol]
Anatol J Cardiol. 2017; 18(3): 206-212 | DOI: 10.14744/AnatolJCardiol.2017.7628  

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Hiroki Niikura1, Raisuke Iijima1, Hitoshi Anzai2, Norihiro Kogame1, Ryo Fukui2, Hiroki Takenaka1, Nobuyuki Kobayashi2
1Division of Cardiovascular Medicine, Ohashi Hospital, Toho University Medical Center; Tokyo-Japan
2Division of Cardiovascular Medicine, Ota Memorial Hospital; Gunma-Japan

Objective: The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients.
Methods: Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay.
Results: There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.40.7 vs. 7.51.3 mg/day, p=0.63), mean duration of the use of TLV (4.33.5 vs. 5.44.8 days, p=0.17), or mean length of hospital stay (16.57.8 vs. 15.78.0 days, p=0.64).
Conclusion: TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.

Keywords: acute decompensated heart failure, tolvaptan, very elderly, worsening renal function


Hiroki Niikura, Raisuke Iijima, Hitoshi Anzai, Norihiro Kogame, Ryo Fukui, Hiroki Takenaka, Nobuyuki Kobayashi. Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure. Anatol J Cardiol. 2017; 18(3): 206-212

Corresponding Author: Hiroki Niikura, Japan


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