Matsumoto K, et al. - Tolvaptan (TLV), mostly used for patients with acute decompensated heart failure (ADHF) refractory to conventional diuretic therapy, is a newly developed oral vasopressin-2 receptor antagonist. Researchers evaluated the impacts of outpatient TLV dose on cardiac mortality in patients released after hospitalization for ADHF. Worsened prognosis may not stem from judging the continuation of low-dose (LD)-TLV according to patient hemodynamics and severity of congestion.

Methods

• This study included 105 patients with ADHF treated with TLV for the first time while hospitalized, split into three groups on the basis of outpatient TLV use and dose.
• The non-TLV group included patients who were not treated with TLV after discharge (n = 36), while those who did get TLV after discharge were split into 2 groups: low-dose (LD)-TLV (3.75 mg/day, n = 27) and high-dose (HD)-TLV (7.5 or 15 mg/day, n = 42).
• Cardiac mortality was the primary endpoint; the composite of all-cause mortality or re-hospitalization due to worsening of ADHF was the secondary endpoint.

Results

• Demographic variables did not significantly differ between the three groups, other than body mass index (p=0.0026), echocardiographic data, laboratory data other than serum chloride before TLV administration (p=0.041), serum sodium (p=0.040) and potassium (p=0.027) at discharge, and concomitant medications.
• In HD-TLV vs non-TLV, lower survival rate was seen via the Kaplan–Meier curve, whereas LD-TLV had the highest survival rate (p=0.0001).
• After adjustment for predictive covariates, LD-TLV (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.01–0.93, p=0.040) and HD-TLV (HR 2.43, 95% CI 1.06–6.26, p=0.035) were recognized as significant predictors in multivariable Cox regression analysis of the clinical characteristics used for predicting cardiac mortality.